Being Declined for Individual Health Insurance

...and what to do about it

Health insurance companies in most states are not restricted from declining applicants for individual health insurance coverage for any medical reason so long as underwriting standards are applied consistently from one person to the next.  Being declined for individual health insurance is something to be avoided if possible and to do so takes a little extra care.

There are certainly many kinds of health conditions which many individual health insurance companies will refuse to look at.  For example, if you have recently had a heart attack or cancer you most likely will not be able to qualify for individual health insurance.  There are too many conditions to list here but your application will be rejected if the health insurance company thinks there might be a high probability that you will file a claim at some point related to a condition you have already been treated for in the last 5 to 10 years.

Here are some of the most common reasons that people get declined for individual health insurance:

• Obesity
• Uncontrolled High blood pressure greater with readings of 140/90 or higher
• Cholesterol or triglyceride readingo utside normal limits
• Ongoing joint problems - back, knee, etc.
• Smoking.  If you smoke you greatly increase the chance that you application will be rejected even though smoking by itself is not usually something that you will be declined for.
• Headaches
• allergies

When I used to sell individual health insurance, I used to tell people that it is very difficult to obtain.  Most did not believe me until they received a rejection letter stating that their application could not be accepted for fairly common medical problem like headaches or allergies.  What they didn't understand is that even though these are not life threatening conditions they can cost an insurance company tens of thousands of dollars.  High blood pressure is very uncommon but it people at increased risk for heart attack and stroke as does obesity.

If you apply for individual health insurance and you are declined for some reason this information will be stored by the Medical Information Bureau in Massachusetts.  There are a lot of misunderstandings about the MIB but it basically it serves health and life insurance companies to prevent fraud.  While it is always of paramount importance to be truthful and accurate on any application you fill out for health insurance, you will still want to avoid getting a formal rejection from a health insurance company that will then be kept on file at the MIB.

A good insurance health insurance agent should be able to tell you whether you have utterly no chance of getting an individual policy if you have a major health issue.  But for many people it is not so clear cut since there are usually many different health insurance in any given market and each one handles underwriting differently.  If you blood pressure is borderline, or if you are between certain weight categories, for example, or if there is any uncertainty as to which way it might go, here are the steps you need to follow:

• Find out all of the major and reputable health insurance companies in your area that offer plans that you might want to consider.
• Find an agent who represents these plans.  If one agent can't be found to deal with all of the plans, find more than one agent.
• Once you find an agent explain your situation.  He should be able to tell you whether you have any chance whatsoever.  If you are told not to bother, it may still be worth while to find another agent especially if you have a condition like high blood pressure, headaches, cholesterol, etc.
• Ask the agent to submit a pre-screen on the condition or conditions in question.  A pre-screen is a summary of your medical history that you reported to an agent.  It will allow an agent to get an opinion from underwriting before you actually submit an application.  This is the way to avoid having a decline submitted to the MIB.

Just because it might be determined that you will not be able to get individual health insurance when you apply for it doesn't mean that you will never be able to get it.  Weight can be lost, cholesterol can be lowered, blood pressure can be controlled, and someone can stop smoking.  If you receive a pre-screen which indicates that you will be declined because of high blood pressure, go see your doctor.  This might be the only thing an insurance company is concerned about.  Once you have risk factor under control for a little while you will greatly improve your odds of getting covered.  Not only will you be able to get health insurance you will probably increase you life expectancy as well which is the most important thing of course.