Notes from a Doctor's Practice

Medical underwriters are indeed "misfortune tellers". It's true that 1% of policy holders are responsible for 40-50% of most insurance policy claims. Their job is to hunt you down, you 1%, and deny you coverage.

Let me state the obvious: I am not telling you or your loved ones not to seek help because of the fear of being denied further coverage. Any good physician can help you out with an appeal if concerns are baseless. Most of us are up for a good fight.

    Social smokers. This is for our group of dabblers (the "couple of cigarettes a day" group). If you EVER smoked and you have any other condition (allergies, asthma, skin cancer, etc) they will get rid of you. If you smoked in the remote past you have to wait until your risk goes back to baseline and here is how you figure that out: if you smoked a pack and a half a day for 10 years (even if you quit) that is a 15 pack year history.

Guess what…it takes you 15 years for your risk to come back to a nonsmoker and until then they won’t bet on you.

    Medications you take that will screw you. Antidepressants and anxiety medications are a big red flag for insurers. Xanax taken before a plane flight led one of my patients to a fight later when denied coverage for an "anxiety disorder".

Medications used for dual purposes will cause you problems when your potential insurer sees that you take them: antidepressants, anxiety medications, oral chemotherapy medications also used for skin conditions, diabetes medications used for patients with polycystic ovary syndrome... you get the idea.

    Take back the back pain. Back pain is such a common complaint and most of the time no big deal, right? Nope. Medical underwriters know that 1% of the time the problem will worsen as time goes on and will become exponentially more expensive. Though many patients want imaging (MRIs, etc.) done for their back pain this will follow you forever like a bad tattoo. Just having an MRI performed will up the ante.

If you are found to have degenerative disc disease (spondylolysis, etc) your uphill battle for coverage has begun. Imaging of the back and prescription anti-inflammatory or narcotic pain medications will make them run for the hills.

    Singing the Blues. Mood disorders like depression, anxiety and bipolar disorder are seen by medical and long term insurance as expensive, chronic, and progressive over time. Depression is the most common cause of disability in young people in the U.S., so policies will deny you for this.

Patients with associated conditions like chronic fatigue and fibromyalgia are starting to get lumped into this category in the minds of those assessing risk.

    Obesity, the new tobacco. Before they know your name they will know your body mass index (BMI). If your BMI is 30 (the official cutoff for obesity) or higher and you have ANY other MINOR medical conditions like asthma or seasonal allergies, you will be denied.

    Oh my aching head. It's ok to get a bad headache, even a migraine, but not if it has ever brought you to an emergency room. Add imitrex to your headache remedy or TWO non-narcotic prescription medications and you will have a denied stamp across that application you filed out.

    Not so sweet, Diabetes. You figured it was a no-go with diabetes and you are right. Here is your only way in to the club: your sugars are controlled with diet alone and you have a BMI around 25. Add even the smallest thing to that like psoriasis and your application is in the shredder.

    Chest pain by any other name. Watch it here; this could literally be any kind of chest pain. I have fought insurance companies who deny young men who had doctor visits for musculoskeletal chest pain or chest pressure associated with anxiety symptoms or panic attacks. One of our largest medical insurance companies denies young men or women individual medical insurance because of a history of chest pain even with normal EKGs and heart studies.

WATCH for any mention of chest pain or pressure that appears in your medical record and ensure your physician documents the reason for the "atypical chest pain."

    "Blood is thicker than water". Here is how your family bonds will screw you. We all know that early heart disease and cancer in the family spells misfortune. For long term care plans they have a much bigger concern. Mention that your mom, dad, brother or sister had Alzheimer’s and you are in trouble.

Remember Alzheimer's is the only dementia that is believed to have a genetic link so the generic "dementia" in a relative is a much safer story if you get my drift. It was dementia and you weren’t positive it was Alzheimer’s.

    Beauty is only skin deep. What's hidden under the skin is more important than physical beauty, unless you are a medical underwriter. The single most common malignancy in the U.S. is skin cancer and if you have had a basal cell or squamous cell carcinoma that required reconstructive surgery or you had more than one…well, then, you aren’t so beautiful to them.

Dr. O.