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Unknown Diagnosis Leads to Insurance Refusal

By:
David Lack

Question :

I was just turned down for insurance. It seems I was diagnosed a year ago with chronic lumbar radiculopathy, but I was never told this diagnosis. The doctors just told me it was stress and age (I'm 24). The back treatments were making me worse, so I began doing acupuncture and yoga, and I'm feeling fine now. But this diagnosis has come back to haunt me. How can I overturn this? Can I see a new doctor and have him testify that I am fine? Will this be removed from my record over time, or will it stay with me forever? I'm getting the runaround from both my old and my new insurance company. I know that even if my back acted up again, I wouldn't be using the insurance company's services. I would pay for alternative therapy out of my own pocket.

W.H.

Answer :

In the course of their record-keeping, doctors must enter diagnosis codes for the patients they see and treat. Unfortunately, few of us know exactly what information is in our medical files. You probably assumed that your physician put something in your records from your encounter a year ago, but you had no idea that it had such a name and that it could affect you later. Couple this with the fact that insurance companies are very skittish about back problems, and you find yourself denied insurance coverage.
When considering an application, insurance underwriters rely heavily on medical records. They may even compare medical records with information provided on an application. Since you were not aware of the diagnosis in your medical records, you could not disclose it on the application for insurance. You may have disclosed that you went to the doctor for a sore back and received treatments, and this would have prompted the underwriter to consult your medical records. When the underwriter found the diagnosis, two things may have come into play. First, the diagnosis may be serious enough to cause the insurer to deny your application. Second, the underwriter may have assumed that you were concealing something, and this does not sit well either.

So based on the available information, the insurance company made an adverse determination. But this is not the end of the story, and there may be something you can do about it now. Your medical records will indeed follow you for the rest of your life, but insurance companies do work with a kind of "statute of limitations" on some medical conditions. They may say, for instance, that a person who is symptom-free for five years after a back injury is insurable. Even cancer survivors and heart attack victims can go beyond a certain time period and be insurable again. So your back condition could eventually disappear as an insurance risk factor.


At the same time, you could go to a doctor for a complete examination and a new diagnosis. If current records show that a problem is cleared up and no longer a factor, the insurer may take that into consideration. You could go to a doctor and, if the problem is truly gone, have those records and a physician's statement sent to the insurance company for reconsideration. You may even write a letter on your own behalf explaining your understanding of the problem and steps you have taken to go beyond the problem. You may also speak to the doctor who made the diagnosis and ask for clarification. Perhaps she or he made a mistake that could be easily corrected.

The point is this; with a modicum of effort, you may receive a clean bill of health and be insurable once again. In fact, it is your advantage to do this, so that your records will show you to be a good insurance risk.


Insurance companies love to insure healthy 20-somethings, and that probably includes you. You just have to set the record straight. If you feel you are well beyond the problem of a year ago, you can probably convince the insurance company (or another one) to reconsider you. If you reapply, make sure that you disclose everything you now know and, hopefully, you can also say that you have been given a clean bill of health.

 

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