Do insurance companies know if you have been to see a doctor already/?

Question

If you wanted to get health insurance, but have already been to see a doctor about a problem, would the insuarnce company be able to find out? Cos they say if it is a "pre-condition" they wont insure. Yet, if I didnt go to the doc, and got insuarnce, and THEN went to the doc it would be covered! Go figure!
Will they know??

Answer 1

First, I want to correct statements made by three previous answerers: the Medical Information Bureau (MIB) will ONLY have information about you IF this information is reported to it by a member insurer (not all insurers are members). The information is received by the MIB ONLY during the underwriting process. In other words, doctors DO NOT report to the MIB; and health insurers DO NOT report claims received to the MIB, either.

A pre-existing condition will be defined in the policy. Not all policies require actual treatment in order for a condition to be considered pre-existing. The majority of policies I've reviewed (literally hundreds) state that symptoms which would have prompted a "reasonable" person to seek care indicate a pre-existing condition. So the absence of a diagnosis or treatment doesn't restrict an insurer from arguing that a condition pre-exists the coverage.

So will the insurer find out that you've had treatment? There's no way for any of us to conclusively answer this question. Maybe they will and maybe they won't. But if you lie on the application and the insurer finds out about it within 2 years from the effective date, the insurer can void the contract (this is known as "rescission") if it would have taken some other underwriting action had it know the correct information. If it's paid ANY claims at all, related to your pre-existing condition or not, it will retract the money and you'll be stuck with the bill. So it's really best to be truthful on your application.

If you apply and are declined, call your state's insurance commissioner's office and ask whether your state has a "high risk pool" for uninsurable individuals. If there isn't a high risk pool, ask for advice based on your circumstances.

One final comment: another answerer suggested you obtain treatment under another name. This is insurance fraud and I don't suggest you follow his advice.

Answer 2

"Utmost good faith" is the term that we always use and explain to our customer, kindly declare everyhing before signing the policy.

You can ommit certain information during the application (with or without intention).

But when it comes to claim, this is where they will start digging information about your health for any pre-existing condition. Remember you may already paid premium for a few years, if they found out the discrepancies they got every right to refuse payment.

if your sum insured is huge, you are require to undergo a medical checkup, then the doctor will be able to find out the truth and report the truth, the result is your application can be rejected or they will impose some restrictions or exclusions.

kindly declare everything and let the insurer decide on your application.

Answer 3

Every time you go to the Doctor, your records get updated on a database called the MIB (Medical Information Bureau). If they find a condition like diabetes (or other conditions that won't go away easy), you can be sure that it will appear on the MIB, and some insurance companies will think twice about insuring a person (depending on how serious/advanced the condition is).
If you have not seen a doctor for your condition, it won't be on the MIB; so the insurance company doesn't have a way to know. However that will put your health in jeopardy, and depending on the terms of your Health Policy, if they discover your condition after you get insured, they might revoke your coverage (you need to talk to your insurance agent/broker about these clauses).

Answer 4

Yes they know. It doesn't matter if you paid as long as your name is on the chart and the doctor wrote in it they can read it. Be extremely careful when seeking mental health services because the insurance companies will absolutely hold it against you. Apparently people who have short lasting conditions like depression (temporary) are punished for years to come for getting the help that they need. When you apply for insurance you are giving them the ability to read whatever is in any chart that you have at any Doctor's office. Read the fine print and realize that they are out to make a buck not keep you healthy.

This is why it's best to avoid preventative care under your real name when you are not insured. If you are paying out of pocket then why not make up an identity like Clark Kent or Joe Smith and get the care you need without repercussions.

Answer 5

it depends...if you went to the doctor before you had insurance and were indeed a self-pay client and then got insurance and went back for the same thing, insurance may deny you. it all depends on your diagnosis. if it is a pre-exsisting condition they most likely will---but that is mainly for someone who has an "expensive disease or condition" such as cancer where they will be submitting a ton of claims and spending a lot of money.

insurance companies are a huge d i c k around, i work in a doctors office and we have claims being denied all the time for stupid reasons.

i hope i helped and didnt just confuse you more :o)

Answer 6

Yes, there are two ways the insurer will discover this:

1. Request medical records from your doctors. If your policy requires proof of good health, then you signed a form allowing them to contact your medical provider for a copy of your file. Or, if you didn't have to provide this at application time then you will do it at claim time. So, either way. Some people "fail to mention" another doctor that they saw as a way of hiding pre-existing conditions, but this is obvious when there is a gap in medical providers or your physician references another doctor in their file. They can also request info from your pharmacy about medications you are taking.

2. MIB - medical information bureau which another poster provided information about.

Also, check your policy language. Insurers are starting to update language in the policy to not only exclude pre-existing conditions that you sought treatment for but also medical conditions that a reasonable person should have sought medical attention for - and that way they are trying to stop people from withholding medical care for themselves in order to become insured before they see a doctor.

Answer 7

Yup.

The MIB -Medical Insurance Bureau keeps tabs on all that stuff. Read all about it at:

http://www.mib.com/index.html

By the way, YOU, as the consumer, can get a copy of your record to see what the insurance company sees. Go the web site.

If there is NOTHING there -which is as likely as not- and then you fail to answer insurance questions truthfully; the concealment may be taken as fraud and any claim may be denied, or coverage cancelled.

Answer 8

It is possible that they will find out. Some plans routinely send "pre-exisiting questionnaires" to doctors at certain times of the year, and often they ask for copies of the chart to be sent with it.
(Yes, it's legal, it does fall under HIPAA guidelines because it's for payment.) That would be the only way they'd find out.

Answer 9

Yes, they will be able to find out. Then they cancel your policy, and possible (if it's a big deal) can prosecute you for fraud.

Don't lie on the application.

Answer 10

they usually send u to visit one of there doctors