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How to avoid future claims problems.

Don't take lightly the process of filling out your application for a Florida health insurance plan, or any insurance for that matter.  Try to remember that this is the first part of a contract between the insurance company and yourself. 

Don't give the insurance carrier an excuse not to pay a claim. 

How is that possible, they are agreeing to cover me up to 3 or 5 million????

Not to burst your bubble but insurance companies don't get to be huge by giving away a lot of money in claims.  If there's a legitimate way of getting out of paying a claim,  you can rest assured they will be trying there darndest to figure out how it is.

Tip #1: Be as accurate as possible when asked about your medical history. How is that possibly, you say, when they are asking me to go back 10 years ?

Keep your head man!

If you can't remember exact dates or medical jargon simply say so on the application.  When claims are denied they have to show a pattern of misrepresentation or deception. 

If you can't remember the name of a doctor from a few years ago don't just leave it blank.  Insurance companies don't like blank spaces on an application and assume you are leaving out important details they should know about.  Stop filling out the application,  whether it's online,  with an agent or over the phone with the insurance company. 

If you need to, pull out old check books to look for the name of doctor, talk to family members or if you've moved to a new location,  try calling some old friends or someone that might be able to jog your memory.  Don't leave it blank or say you can't remember.  Insurance company Underwriters will assume you are trying to conceal something about a previous illness or accident.

Any health insurance company, not just a Florida health insurance company,  wants to avoid paying future claims if they can.  So they try to weed out the people that are the biggest risk to their bottom line:

• They are trying to figure out if you have any chronic illnesses, or past accidents, that will require future treatment.  Are you taking medications for a past illness and if so what medication and what dosage? Has a doctor recommended a test or even a surgery which you haven't completed? They want to know about it if one has.

• They want to know how risky you are. They are willing to bet a lot of money...sometimes $3 or $5 million bucks in coverage, that you won't be a future claim.  They are comparing you based on you age to health people.  How do you stack up in terms of your height and weight?  Do you smoke or have high blood pressure or cholesterol issues?  True almost everyone over the age of 50 does but it gives you a unique medical risk to them.

• Finally, they also want to do know a little about what you do for a living because some jobs are more risky then others.  You might be exposed to more chemicals, crazy people (bartenders) or even risky sports or hobbies...sky diving,  motorcycles etc.

If a doctor prescribed a medication for you and you feel you are in such great shape they you don't need to take it anymore....you will be declined.  Reason being, you are walking around with an untreated, and potentially uncontrolled medical condition.  If you don't need a medication anymore, do so under the direction of a doctor. 

If you have  a preexisting medical condition the Underwriters want to see that it is being well controlled for at least 6 months or a year. If, for example, you were recently put on high blood pressure medication, you are probably going to have to wait to apply because the Underwriters want to make sure the medication actually works and can control your blood pressure.

Height and weight: you may have gained weight since your last doctor visit or maybe not.  In either case it's helpful to put down what your current weight is.  Many applications ask if you have had weight gain or loss of 10 or 15 pounds in the last twelve months.  Be truthful, and for you women out there, try to remember no one is paying attention to this stuff except for an Underwriter.

The phone interview: a lot of times the answers you put on an application are still not quite clear enough to an Underwriter. They will call you and ask for more information.  Again, DON'T PANIC.  Stick to the facts and avoid throwing around medical terminology that might not be accurate.  If you had a basal cell removed two years ago don't tell the underwriter you were treated for skin cancer.  They listen very carefully to what you say and record it.  If you don't know the answer to a question simply tell them you will call them back with the correct information they need. 

I hope this information was somewhat helpful in preparing you for what to expect if and when the time comes when you apply for a Florida health insurance plan. As local, independent agents we are here 24/7 to help you with not only the application but also our existing clients as the situation warrants.