Getting Denied For Health Insurance is Easy


Today shopping for individual private health insurance online is fairly simple. Simply type the keywords “health insurance” on any major search engine such as Google, Yahoo, or MSN and you are virtually guaranteed to come across a multitude of websites with designer custom made plans. However, too often consumers who are simply weighing their options forget the bigger picture. It’s called medical underwriting. Medical underwriting is a process in which an insurer will evaluate under what terms and provisions they will insure an applicant if at all. Many times shoppers spend months trying to find the perfect benefit plan for the best price only to find out the plan they applied for came back after they submitted the application with a much higher price than anticipated or worse, they were declined coverage altogether and now cant get individual health insurance because they passed up what their employer offered.

Getting approved for individual health insurance coverage is not so easy.

If you had group insurance offered by your employer for most of the time you had coverage and this is the first time shopping for individual private health insurance, do your self a favor don’t just shop to get a feel for the market, take the next step and apply. Applying for coverage is the only real way you will really know what offer will be given to you and under what terms or price. Consult with a knowledgably licensed insurance agent who is familiar with the medical underwriting guidelines of the major medical insurance carriers offering the coverage you seek and begin to initiate the application process. All insurance carriers on the individual market will require an application to be complete with the first month’s premium deposit for consideration. The reason why insurers request this deposit is to ensure the applicant is serious about applying since they will incur administrative cost to determine if they will insure you or not, however some insurers will only withdraw funds if your approved while others will take the first months premium deposit and refund you if you decline their offer or if you are declined coverage altogether. Basically the entire process is two fold while you are considering them they are considering you.

There are many reasons why an insurer will come back with a much higher price than anticipated in regards to the benefits you apply for or decline the application altogether. Here are just a few common examples.

Height and Weight: The physical condition of a proposed insured is of basic significance in underwriting. One of the determinants of physical condition is build. Build includes height, weight, and distribution of the weight. Experience has shown that being overweight increases the likelihood of death or sickness at all ages so for an insurer to justify the cost they will raise your rate accordingly if accepted.

High Blood Pressure: Hypertension or High Blood Pressure is an intermittent or sustained elevation of diastolic or systolic blood pressure. Hypertension is a major cause of stroke, cardiac disease, and renal failure. Complications occur late in the disease and can attack any organ system. Cardiac complications include coronary artery disease, angina, myocardial infarction, heart failure, arrhythmias, and sudden death. Neurologic complications include cerebral infarctions and hypertensive encephalopathy. Hypertensive retinopathy can cause blindness or glaucoma. Reno vascular hypertension can lead to renal failure. Just because it is controlled does not mean an insurer will accept you, also any combination of High Blood Pressure, High Cholesterol, and Obesity almost always result in a decline with most carriers or at least a very high premium. The reason for all of this is from the insures point of view at very best you will create medical expenses in the form of diagnostic test, assessments, treatment, medication or at worst heart attacks and kidney transplants costing lots of money.

Smoking: When an individual uses tobacco in any form, whether it involves chewing, dipping, or smoking cigarettes, cigars, and a pipe, is an important risk factor by itself. In the past smoking or other tobacco use was considered in underwriting, but only rarely as a factor of importance by itself. For example, if a person had a respiratory problem and smoked, the underwriting decision might be less favorable than for an otherwise similarly situated non smoker. Smoking unaccompanied by any other negative factor however, was not a cause for a less favorable rating and continues to be ignored as a factor in many markets worldwide. Insurers now understand that smoking and any other tobacco use, even in the absence of any other negative factor, causes expected mortality and morbidity to be worse than average and the degree of variation is of such significance as to warrant separate classification. So important is this factor that the average female smoker can be expected to pay almost double the rate of the same non smoking male of the same age.

Occupation: Occupational hazards are not as important today as they were in the past, although in certain cases they can be. They may increase the risk in at least three different ways. First, the occupation may present an environmental hazard, such as exposure to violence, irregular living, or a temptation to experiment with drugs or overindulge in alcohol. Second, the physical conditions surrounding an occupation can have a bearing upon health and longevity, as in the case of persons who work in close, dusty, or poorly ventilated quarters or are exposed to chemical toxins. Finally there is the risk from accident, such as is faced by professional automobile racers, crop dusters, and scuba divers. An individual who has recently changed from a hazardous occupation to a safer form of employment must be underwriting carefully, as he or she may still retain ill effects from the earlier job or because the change may have been prompted by a health factor. It is common to see increased premium rates for bartenders, telemarketers, tattoo artist, truck drivers, actors, singers, artist, and servers to name a few if they get accepted at all.

Alcohol and Drugs: Information is usually sought regarding the proposed insured’s use of habit forming drugs and intoxicating beverages. Excessive alcohol use is associated with higher than standard mortality and morbidity meaning increased likelihood of death or sickness. If the individual applying for coverage uses alcoholic beverages in large amounts, he or she may be declined or offered substandard insurance while having to pay more to receive benefits, depending on the degree of usage. Use of alcohol in moderation is considered normal. Use of drugs not prescribed by a physician or drug abuse may call for a declination depending on the type of drug. A history of misuse or unsupervised use may require an extra rate increase depending upon the length of time since the drug or drugs were used, the nature of the treatment given, and whether there has been participation in a continuing support program such as Alcoholics Anonymous

Hazardous Sports and Avocations: Persons with a higher standard of living and searching for new ways to spend their leisure time often resort to hobbies and avocations. Such activities as scuba diving, mountain climbing, competitive racing, hand gliding, and sky diving clearly can involve a significant additional hazard to be considered in the underwriting process. If a hazard causes increased expected mortality and the individual is insurable on some basis, he or she usually is charged a flat extra premium commensurate with the risk. A rider excluding death or hospital expenditures resulting from participation in the hazardous activity may be employed occasionally. Also, riders excluding coverage for accidental injuries caused by football, basketball, or baseball players are not uncommon.

Anything: For those that think you are perfectly healthy, you are in for a big surprise. Even if you were never officially diagnosed with an uninsurable medical condition and by the way the list is endless, if you have not had coverage for some period of time a paramedical examination will have to be performed and insurers will be evaluating the test results very closely. Special attention will be given to the liver enzymes such as bilirubin, certain pressures in the kidneys such as the glomerular filtration rate which measures the rate of clearance of waste toxins you are capable of removing from your body and certain proteins in the body such as albumin. There really is not enough room within the scope of this writing to cover everything but it is important that you understand the reasons an insurer will decline your application or make you pay much more than anticipated is unlimited.

As a final note: The best advice I could give to consumers considering individual health insurance coverage is to avoid trying to do it yourself and instead seek the services of a licensed professional insurance agent who is not a captive agent working primarily with one carrier but is appointed with many carriers so he or she can place you with the carrier who will issue the coverage you seek with the price you can afford. Just remember you really don’t know what you get until you apply. If you are accepted and you don’t like the offer the insurer offered you, you can simply refuse and get refunded your fist month’s premium as long as you are within your free look period as mandated by applicable state and federal law.

For those of you still not ready to apply but need more questions answered please feel free to login to our website at and register your information and one of our consultants will be happy to assist you even if you are not yet ready to apply. At the very least by speaking with one of our consultants you will have a more accurate picture of what will happen whenever you are ready to initiate the health insurance application process with the insurance carrier you select.

Source by Carlos Diez

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