Monday, October 11, 2010

How Will the Insurance Company Find Out?

"If I don't tell the health insurance company about (name any illness), how will they find out?". I always cringe when this question comes up. Got a call like this today from a former client.

I say former because he bought health insurance from me a few years ago, including maternity with no waiting period, so his wife could get pregnant.

She did, she delivered, he dropped the coverage.

Then last week he called again. Just like before, did not want health insurance on himself, nor on his son (who is on Peachcare . . . Georgia's SCHIP plan for low income families), just on his wife.

My spidey senses were tingling.

"Is she in good health?" I asked.

"Oh yes, I just want to get health insurance on her just in case."

I wanted to ask "in case what" but I didn't.

Today he called back and wanted to know which health insurance plan I would suggest. I said the plan from Humana was a good one and the one I would probably buy if I were in the market.

"How soon can we make it effective?" he asked.

"Usually a couple of days. Why do you ask?"

"She is waiting on some tests. The doctor thinks she may have Lupus".

There you go. The cat is out of the bag.

"Well, she won't be able to get health insurance until the tests come back and if confirmed that she has Lupus, she will not be able to buy health insurance then either".

"Why not?"

I hate that question almost as much as the one that followed.

"The carrier will ask on the application if she is waiting on test results and when they find out they will postpone the health insurance application until the tests come back".

"So how will they know if she doesn't tell them?"

"They have ways of finding these things out. If they don't find out before underwriting, they almost certainly will if the tests come back positive for Lupus."

"What kind of ways?"

"I tell you what. Let's just forget about any of the plans I sent you and you should have her apply for PCIP, the Obamacare plan that is designed for this kind of situation."

"How much does it cost? Is it more expensive than the Humana health insurance plan?"

"Probably, but it doesn't matter since, based on what you have told me, she won't qualify for Humana or any other health insurance plan besides PCIP."

"OK, send me the information, I think I will wait until the tests come back before applying."

"Sounds like a plan . . ."

I hate calls like this.

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