Health Insurance Brokers Can Help You Avoid Getting Rejected For Having Been Rejected

When shopping around for health insurance, getting a rejection on your record can turn off other providers from granting coverage. The trick, then, would be to know what your rejection chances are, based on your personal stats and preexisting conditions, before applying.

Considering the racket’s typical inscrutableness, this is often quite difficult, so Kiplinger advises hooking up with an insurance broker specializing in individual coverage. The broker’s experience can help guide you towards providers more likely to accept you. They can also call up the provider’s underwriter and suss out some of their basis of determination in advance.

Avoid Being Rejected by Insurers [Kiplinger]
(Photo: Getty)

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  1. Hambriq says:

    If you don’t mind putting yourself at risk for fraud, here’s some advice: tell your insurance companies you don’t have diabetes/hypertension/asthma/high cholesterol, etc. etc. Then tell your doctor you don’t have insurance, so could he please prescribe something that isn’t ungodly expensive? (Simvastatin instead of Lipitor. ACE Inhibitors like Lisinopril instead of ARBs like Diovan or Benicar. I could seriously go on for years with cost-saving suggestions.) Then, don’t put any of those drugs on your insurance. If you’re lucky, HIPAA privacy laws will protect the pharmacy from telling the insurance companies what medicines you are taking, and you may get away scott-free. In most cases, the generics are going to cost less than your copays anyway.

    Or, you may get busted and get sued for fraud. Risk vs. reward?

  2. Hambriq says:

    Also, here’s another idea that’s 100% legal. Stay healthy. The majority of the drugs that come through my pharmacy are maintenance medicines for highly preventable diseases; blood pressure, cholesterol, diabetes. Or completely optional medicines like painkillers, sleep aids, etc. etc.

    Sometimes, it’s beyond your control. Sometimes you get hit by a drunk driver and live with chronic pain so you have to take 8 Vicodin a day. Sometimes you just get dealt a shitty hand of genetic cards and your heart is as effective at clearing shit away as my toilet pipes. I’m not so much of an asshole as to believe stuff like that is 100% preventable. But I’m also not dumb enough to believe that it’s 100% out of your control.

    The amount of money the health care industry could save if people just lead healthier lifestyles is ungodly. But I’m a realist. I know people love their sedentary lives, so how about this: give people the option to pay lower copays (and in turn, get fewer bad marks on their insurance) for generically available drugs instead of immediately leaping to prescribe Lipitor to every patient with high cholesterol, Avandia to every diabetic, Ambien CR to every person who has trouble sleeping, etc. etc.

  3. gorckat says:

    The drug prescribed has less to do with the insurance company than the doctor. That’s why so many companies have formularies and preferred medication lists.

    But the healthy living part is good sense.

  4. Buran says:

    @Hambriq: Given that you are not their doctor, it’s not your call to make as to what’s “preventable” with anyone. It’s too easy to get on a high horse and point and laugh, but fact is, you just don’t know. I’m sure 90% of the people who are on whatever medication would rather not be.

    Two of my immediate family members was on Lipitor for a while and they are not exactly flabby, yet you have them stereotyped already! They haven’t had ANY other health problems in a long time, and yet in your mind they’re scum.

    Go to medical school, do your residency, become their doctor. Then you’ll be qualified. Until then, you’re not. And don’t give me that “but I’m a pharmacist” thing (if you are). You’re still not qualified nor are you in possession of their medical records.

  5. acambras says:

    IIRC, HIPAA dictates that if there hasn’t been a lapse in coverage of more than 60 days, a “new” insurance company can’t discriminate against you for pre-existing conditions. You call your “old” company to get a Certificate of Continuous Coverage, which you then present to the “new” company.

    I might be off on the details, but I’m pretty sure that’s the general idea — to keep people with pre-existing conditions from being discriminated against.

  6. enm4r says:

    @Buran: I’m sure 90% of the people who are on whatever medication would rather not be.

    And 90% of people only think about the consequences after they’re personally affected and it’s already too late.

    And yes, it is easy to hop on the high horse and at least question whether or not something was preventable. I think that’s a question we should be asking, instead of immediately jumping to sympathize with someone simply because they have condition A, B or C. I’m not accusing or laughing when things like this occur, but I think we must truly be objective and take a deeper look to see if everyone really is just misfortunate/unlucky (at an increasingly common rate!) or if they can shoulder some responsibility, regardless of whether or not they want to now accept the consequences.

  7. Hambriq says:

    Hey, douchebag. Did you not read where I said, “I’m not so much of an asshole as to believe stuff like that is 100% preventable“? Did you not read where I said, “give people the option to pay lower copays (and in turn, get fewer bad marks on their insurance) for generically available drugs instead of immediately leaping to prescribe Lipitor to every patient with high cholesterol“?

    If you had the opportunity to pay a significantly lower copay for a drug that was between 96% to 100% as effective as Lipitor, would you? What about if you knew that a month’s supply of Lipitor costs the insurance company $124.99 whereas Pravastatin costs $53.59? Do you really think the insurance company isn’t going to get that money out of you eventually?

    Even if you wouldn’t, my point is that the option should be there. But, I like how you ignored the larger point just so you could get offended and crawl up on your high horse and blab about how I’m such a bad person. I believe if you actually thought about it, you would find that you agree with me. But whatever.

  8. Cowboys_fan says:

    @Hambriq: Obviously he didn’t read it, or wouldn’t have correlated your comment about high cholesterol with being fat, b/c they don’t always go hand-in-hand.
    It amazes me how these insurers will find any possible reason to deny you/us. I’m not for finding ways around the system, they need to overhaul it entirely, so that the industry is not profit driven.
    For those who say just stay healthy, there are plenty of unhealthy people who don’t end up w/ serious conditions, and conversely, there are alot who are perfectly healthy and still get health problems so its not so simple.

  9. Buran says:

    @enm4r: Responsibility for what? Being sick? I can’t exactly control when I get a cold any more than anyone else can.

  10. Buran says:

    @Cowboys_fan: Exactly. Yet I constantly see “diabetic = fat” type comments from people who act like they can magically peer through the screen at any posters who admit being diabetic and immediately accurately judge their physical condition.

    There’s a good reason why I don’t give away a whole lot about myself. No matter what the case, a bunch of people always pile on me about some slight that is none of their damn business.

  11. Hambriq says:

    Two comments from Buran and yet no acknowledgment of my post, much less any attempt to respond to it. Obviously, you have a leg to stand on. Or, more likely, you’re overly defensive about being diabetic, and when you overreacted unduly, you got called out on it. Two thumbs up.

  12. Hambriq says:

    @Cowboys_fan:

    When you say “they need to overhaul it entirely, so that the industry is not profit driven, there really aren’t too many other options that socializing health insurance. And there’s a huge problem with that. The reason why health insurance prices have gotten out of control is because of the costs involved with health care. Socializing the system does nothing to drive down the costs, it merely spreads them around. If anything, it’s just a very large band-aid on a bullet wound.

    If you want to see positive change, the amount of costs in the health care system needs to be cut down. Of course, this will be tough because people have become accustomed to the idea that optional or unnecessary treatments and procedures will be paid for by someone else. Sonograms. Sleeping pills. Valium. Chiropractors. Therapists. Etc. etc. Again, I’m not saying these things are ALWAYS unnecessary. Let me repeat that previous phrase for emphasis:

    Again, I’m not saying these things are ALWAYS unnecessary. But cutting down on the number of unnecessary medical expenditures will be the key to making health insurance manageable again.

  13. enm4r says:

    @Buran: I’d rather see you acknowledge Hambriq, but since that is unlikely, I’ll respond. Yes, there are preventable measures for getting a cold. If I decided that I wanted to go an entire Chicago winter without a jacket, I would and should be subject to ridicule for having a cold. If, however, I wear proper jacket, etc and still get a cold, then no ridicule is necessary. I think you proved our point quite nicely. Preventive measures should be taken, if they don’t work, let’s examine what’s necessary. But hey, if I want to not wear a jacket all winter and then complain when I get sick, I’ll know who to come running to for my complaints!

  14. Anitra says:

    @Hambriq: Most people I know who are on medication do their best to find the cheapest alternative that still works for them. My mother-in-law had to fight with her insurance company to switch to a cheaper once-a-month pill from her existing once-a-week pill (for osteoporosis, I think). I have relatives on anti-depressants who have asked their doctor if they could reduce the dosage or try a different (cheaper) medication. Unless my family is really bizarre, I would guess most people try to take as little medication as possible, and if they find a cheaper alternative, they ask their doctor and/or insurance company if they can try it.

    Again, an ounce of prevention is worth a pound of cure, but a lot of older Americans are at a disadvantage, because they’ve grown up depending on their doctors to tell them what to do to “get better”. And most doctors are in the drug companies’ pockets.

  15. timmus says:

    Keep your social security numbers off your records. I haven’t been insured for awhile, and on those rare incidents when I go to the doctors office, I omit the SSN. The only place that gave me grief over it was an ER, so I put it down and intentionally mixed up a digit. I don’t know if that will help, but I don’t trust the system and I’m protecting my clean record like my firstborn child.

  16. timmus says:

    (or semi-clean record — the ER visit was for the flu and it was a Saturday morning)

  17. FLConsumer says:

    The MIB (Medical Insurance Bureau) doesn’t forget… nor do they get it right either. Make sure you check with them before trying to get insurance. From what I’ve found, they get more wrong than the credit bureaus do.

  18. Hambriq says:

    @AnitraSmith: “My mother-in-law had to fight with her insurance company to switch to a cheaper once-a-month pill from her existing once-a-week pill (for osteoporosis, I think)”

    Actually, Boniva (the once monthly osteoporosis pill) is comparably priced with Actonel and Fosamax, (both are once-weekly pills); 88.59 vs. 90.99. That’s just splitting hairs though. It’s a really good thing that your family is conscious of the amount their drugs actually cost. I will often discuss the prices of patients copays with them and offer to call the doctor to get their prescription changed, especially if it’s something egregious like Adoxa, Solodyn, Oracea, etc. Or, if they don’t have insurance and the doctor prescribes a brand-only antibiotic like Levaquin. (5 Levaquin costs about 135.00).

    But, at the end of the day, the number of patients who initiate the medicine price discussion is outnumbered 20 to 1 by the number of times *I* initiate it. Unfortunately, for most people, it’s just a load of talk.

    Customer: “Why are my copays so gosh darn expensive?”
    Me: “Well, your doctor prescribed a drug that has no generic available. There are other drugs out there in same class that are equally effective, but have generics available. Would you like me to contact your doctor and request a change in medication?”
    Customer: “Well, no, that’s too much work. I’ll just pay it…”
    Me: “Thank you, come again.”

  19. acambras says:

    I’m lucky enough to have a doctor with whom I can feel comfortable asking for a generic, or asking for samples (esp. if it’s a new Rx and we don’t know about side effects). I guess I figure that if a doctor has seen me naked, I shouldn’t be too embarrassed to ask for the Rx with the lower copay.

  20. Jason.Smith says:

    @Hambriq
    Myself on the other hand, I’ left with a teir 3 medication with no generic, HUMIRA. The only other option is Remicade and a 3 hour infusion every other week. I have no other cost alternative and once I start school in a few months will no longer have insurance. I been shopping around but found that due to my due to my condition Im screwed.

  21. BayStateHealthy says:

    A better option:

    Move to a state that doesn’t allow insurance companies to make decisions based on your health status. In Massachusetts, for example, insurers are required to insure everyone who applies (“guaranteed issue”). The premium level can only vary based on age, industry and county (“no medical underwriting”). Insurers can’t exclude coverage for pre-existing conditions for more than a few months.

    For us, it’s hard to imagine the stories we hear like in “Sicko” or the post, of people losing coverage because of their poor health, or what was on their application. Get your state to reform its insurance laws.

  22. Buran says:

    @Hambriq: 1. I’m not diabetic. 2. I have better things to do with my life than sit here arguing on some stupid website. Thank you for proving one of my points, that people are judgmental about other peoples’ medical conditions without knowing anything about them, with your asinine assumption.

    Fuck off.

  23. umonster says:

    @Buran: For someone who has better things to do than arguing on some stupid website, you talk way too much.

  24. Buran says:

    @umonster: At least when I talk I don’t come in here spewing bullshit judgments about other people that have no basis in fact. And if you think actually typing more than one-sentence answers is “talking too much” well, just scroll on by if it’s too complicated for you.