Many people think that having an insurance denial on their record is a “kiss of death” and prevents them from getting coverage from other carriers. This belief can cost you a lot of money if you have a major claim that could have been insured had you pursued other options.
On almost a weekly basis, we are able to help clients get health care coverage after they have been denied. Sometimes we are able to help our clients get coverage with the same carrier that denied them. Sometimes we can’t help and recommend other options such as Medicare.
In my experience, the only type of medical insurance where a previous denial hurts you is short-term health insurance. (Short-term health insurance offers very little protection and is not something I recommend for many of my clients.) A denial has no impact on your ability to qualify for a group insurance policy.
A denial can have a small impact on the underwriting process for other types of insurance. It may take longer for the company to make a decision. But the denial shouldn’t impact whether or not you will be approved for one of their health insurance plans.
A previous denial will trigger a red flag. However, you won’t be denied (unless you are applying for a short-term policy) because of the red flag. This usually just causes the company to ask you or your doctor additional questions about the condition and the health care you have received for it.
When you apply for a policy, the insurance company wants to make sure that you meet their underwriting guidelines. They are not very concerned about whether or not you met some other company’s guidelines.
If you apply to Company A and they want a person your height you to weigh under 250 pounds and you weigh 260 pounds, they will deny you. If Company B wants you to weigh under 270, they will approve you so long as you meet their other underwriting guidelines.
It makes no sense for the second company to deny you for one of their plans simply because the first company did. It may not seem like it, but insurance companies are not in the business of saying “no.” Although they lose money on those who have excessive claims, they only make money from the people they say “yes” to.
However, if they want you to weigh less than 260 they will deny as well. But it is important to note that the denial will be based on their guidelines. You won’t be denied because you were denied by another company.
Most letters of appeal don’t result in the company making a different decision. However, applying to another company that has more lenient guidelines often does.
There are several reasons why you shouldn’t automatically take a “no” as their final answer. Your condition may improve. The underwriting guidelines may change.
Your condition may be looked on more favorably as it ages. You may have been denied a month after you were diagnosed with a condition and your prognosis was unclear. However, after more time has passed and your doctor’s treatment has proven to have controlled the condition, you may be approved for coverage.
Even if you have been denied by multiple companies, you may be approved by the next one. We can help you in the process by suggesting the company or companies that is most likely to say “yes.”
Please call us with any questions about your health care options. We (Alston and Joel Balkcom) are in the business of helping our Connecticut neighbors find quality low-cost health insurance coverage. We can be reached at 1 800 insurance or 1 203 374 3645.