Looking Good on Paper: The Art of Filling Out Insurance Forms

Getting insurance in the individual/family market if you aren't entitled to guaranteed coverage can be a tough task (see my column "HIPAA, COBRA and PHI, oh my!" for more on how guaranteed-issue individual plans work). Even if the insurance companies accept you, it may not be on the best terms. They may raise the rate you pay (called rated-up), exclude coverage for certain conditions (called a waiver), or both. I have made it a personal mission to see that everyone gets health insurance regardless of health conditions. People ask me all the time how I can get people insured when others can't. It's not hard if you know the ropes.

Group insurance is a sure-fire way, as you can't be turned away (see "Health Insurance: The Road Less Traveled" for a more thorough discussion of group insurance). This week's column deals with individual insurance, the kind that you purchase either from an agent/broker or online. Part of the purchase entails filling out a health history, and here is where people falter. There are people that mark "no" on every question (which is always a bad idea...who hasn't been to a doctor?) or go into so much detail on every cough, sneeze, and sniffle that they wind up writing a book.

It's important to realize what the insurance company is asking for. Most applications only ask for health conditions treated within the last 5 years...be sure to read how far back they go. If it is five years, don't put something that happened 7 years ago in an effort to "be honest" with the insurance company. While certainly commendable, insurance is a legal contract. Only putting down medical care within the time frame asked fulfills your responsibility to the insurance company. If you put it down, they can (and will) use it to protect the insurance companies' interests.

Secondly, the statements you put down on an application are not statements of fact under the law. They are representations or statements "to the best of your knowledge." Knowing this works to our advantage. People are generally loose in their language. Examples of "I'll have an aspirin" when you mean Tylenol or my favorite, "I'll have a Coke" when you really mean any kind of cola drink illustrates this point. Others love to tell you exactly what conditions they had. However, unless you're a medical professional, you shouldn't use exact medical terms. Why? This question is best served by the following real-life example.

A few years ago I had a young lady who insisted on putting the word "myalgia" on her application, as she was "certain" that's what her doctor diagnosed her with. I tried to lead her away from that, but she was adamant. It was no surprise to me when she got declined, but she was livid. How dare they decline her?! Except for her myalgia, she was healthy as a horse! I did some digging and found out that her doctor diagnosed her with "mastalgia," not "myalgia." We got her insured eventually, but if she had followed my advice and put down her symptoms of "breast pain due to too much caffeine," which is what mastalgia is, it would have saved me a lot of time and her a lot of aggravation.

So avoid using medical terms and instead, describe your symptoms and/or use simple terms. A cold sounds better than upper respiratory infection (which is another name for cold). Same goes for drugs. Many drugs treat different conditions. As an example, a drug that is used for restless leg syndrome (a relatively benign condition insurance-wise) is also used to treat Parkinson's disease (a declinable condition). So, if you're not sure of the medication, put down "antibiotic" or "pain reliever" for example, and what condition it's for. If you don't take a prescription on a regular regimen (like once daily) be sure to put down when you do take it...i.e. as needed or occasionally. If you just put down the name of the drug and no usage information, the insurance company will assume it's a chronic condition. Another area that people miss is when things end. If you had a condition, surgery or whatever, and it is all over and done with, be sure to put that on the application with "full recovery" or "no recurrence" if it applies. A word on dates...they don't have to be exact. Remember, they're representations. If you're not sure, you can always put a question mark after the date in question.

I tell all my clients that in the absence of information to the contrary, an insurance company will assume the worst case. It's important to be honest, but there are strategies to help you look the best you can. If you can put things down in a more favorable light, you have a better chance of getting covered at a rate you can afford.

Until next time, stay healthy!