the123

Hi,

New here but have found the forums to be very helpful recently as I am in the process of moving to the states myself.

I have a debacle and would like to hear some opinions with people who have already dealt with health insurers in the US.

I'm moving out to actually work for a major health insurer in the US but I've recently become concerned about my past medical records.

I'm relatively young (22), but suffered a sports injury a couple of years back. After that it was suspected there may have been some further issues however after seeing numerous specialists I have been given a clean bill of health on all fronts (i.e. nothing has found to be wrong with me).

I'm now a bit concerned as to what I should be declaring when getting my healthcare (I believe it is provided by the company and I only pay a percentage of the cost). As I don't want to get into a car accident and all of a sudden find my claim is refused because they found out I had been to x specialist on x date.

I believe under the data protection act here in the uk I can request that my records be changed i.e. since nothing came of the investigation i can ask any evidence of it be removed from my record. Should I have my records altered and not mention anything about the incident or should I disclose absolutely everything?

lansbury

You should disclose everything. If you insurer finds at a later date your failed to do so and you make a claim, you can expect them to refuse to pay out.

I am just changing insurer. The form for the new one asks about previous history, and against each item to check ongoing or finished. I had serious spine surgery in 2010, which completely resolved the problem and I was told it would never reoccur. But I will declare that on the form, with full details.

the123

Thanks for the reply.

Do you suggest requesting my entire medical record from the NHS prior to moving out to the states in order that nothing is amiss?

Cheers

lansbury

I would because they are going to ask questions which you will probably need your records to answer. Plus you have proof of what your saying and details of the doctors who treated or examined you..

the123

Interesting you say that, do they really go into great detail regarding your condition in relation to the policy prior to a claim? Will they likely want to see proof of everything prior to offering coverage i.e. a copy of my health records?

Nutmegger

You are going to work for "a major health insurer" -- don't you have any background in the industry? It seems that your queries are pretty basic as regards how health insurance works.

the123

That's a yes and no, I don't know how the claim process works or what the general attitude is.

Here the FSA set very very clear rules as to what insurers can and cannot refuse claims on, what must be stated when applying what must be disclosed etc.

I've heard a lot of anecdotes for people being refused claims for a heart attack on the basis of once being off ill with back pain and not disclosing this.

In the UK insurers wouldn't get away with such a rejection without providing substancial proof that the two were linked.

Edit:

I know precisely how insurance companies deal with pre-existing conditions, I guess the real issue is are the likely able to find out if I have my health records altered given that they are held and managed by the NHS.

SanDiegogirl

Since you are moving to the US for work purposes I presume you will be obtaining health insurance through your company.

This will be a GROUP insurance policy. The rules and regulations for Group policies are more lenient that those of individual polices in that pre-conditions are not USUALLY a reason for refusal of issuing the policy.

There MAY be a waiting period for such pre-conditions to be covered by the policy (maybe 6 months to 12 months), but even these are usually considerably reduced if one has had coverage of a recognised health insurer up to the time that the Group coverage is taken out. Coverage by the NHS has been recognised by several US health insurers as suitable coverage.

You will need to complete an application form for your Group policy. Under no circumstances do you omit relevant information regarding your health history. Everything must be disclosed. To not do so MIGHT mean refusal of claims in the future. Since nothing was found of an ongoing nature with your sports injury you are able to state that the injury has healed, and you require no further treatment.

Note, I have put some words in 'bold'. Nothing is definite in the world of health insurance in the US, so you need to check with your company as to its general terms and conditions.

By the way, I have never heard of 'changing" medical records - having worked in the medical records field for a number of years, I can't imagine this being done.

the123

Thanks for this.

It's very likely I will be covered by group insurance, I certainly don't plan on heading straight down the doctors when I get there either.

Obviously I have been sponsored to go out there and will start relatively high up the food chain in the company so hope that if I do get hit by a car they wont go digging for a reason not to pay out.

Here in the UK we can request to have to have alterations made to our records provided they don't have clinical significance, as mine don't given the investigations showed nothing more than I am a healthy adult.

That being said I know "being in the industry" that such investigations on my records, despite not leading to anything, raise an unwanted red flag. I don't want to have to pay 500 dollars more a month for healthcare because my shoulder hurt for a bit after a bit of a bump.

RICH

For my company group healthcare plan (Bluesheild/bluecross), I did not have to "apply" ie fill in medical history etc. I just "signed up" on line, chose some options, and my portion of the premium is deducted from my pay.

One time I applied for a private LIFE insurance plan - that involved medical questions and a home visit from a nurse to take blood pressure and so on...

I would say though, "not disclosing" if asked, is a sure way of getting denied payment for services recieved, whereas "disclosing" just might result in denied coverage in the first place. I would rather know up front where I stood!

lansbury

You might not want to pay more, but if you should have done so and didn't because you failed to declare something when the policy was taken out, it could be a lot more expensive.

My 24 hour stay in hospital for surgery set my insurers back $34k. I'm be quite happy if I paid extra for previous injuries, than get stuck with that bill because the insurance company found an outer. Heath care in the US in a business, not a service, at least as far as the insurance companies are concerned.

SanDiegogirl

What do you mean by "its very likely I will be covered by Group insurance"?

Unless you are absolutely sure that your company is going to provide you with Group insurance you should be thinking again about moving to the US.

If you had to start looking for an individual policy then you certainly would be in the realms of pre-conditions and more expense.

With a Group plan you won't pay 500 bucks a month more because you injured your shoulder a few years ago - it probably won't even be an issue.

md95065

If you are going to be covered under a group plan in the US then you will most likely not have any problems.

Firstly, a group health plan can count as pre-existing conditions only those for which you actually received (or were recommended to receive) a diagnosis, treatment or medical advice within the 6 months immediately before you joined that plan.

Secondly, any exclusion period regarding pre-existing conditions must take account of any previous "continuous creditable coverage". Coverage under the NHS counts as "previous creditable coverage" and, if coverage under your US plan starts within 63 days of you leaving the UK then that coverage will also be regarded as "continuous"

md95065

Everything that is asked for must be disclosed.

In my (limited) experience, the applications for group plans ask very few questions other that name, address, date of birth, sex and social security number.

SanDiegogirl

Yes, I must agree that my Group insurance scheme only asked for those details plus age of hubby and sex/age of other dependents.