Margaret Beck and I became acquainted many years ago when our daughters were best friends and soccer players in middle school.
The Marge I knew and admired then was the Marge I know and admire now: smart, strong, funny, cheerful, unpretentious, kind, hard working and easy going.
Marge is a well-respected, top-notch professional, but she’s just as known for her devotion to improving the north state, whether it’s as an active Rotarian or by spearheading Ducky Derby, an annual mega-fundraiser that benefits our community’s youth.
I am pleased to feature Margaret Beck, our newest Q&A expert, of Affiliated Benefit Services in Redding. She and her staff work with employer groups and individuals to provide a wide range of insurance products, as well employee benefits and estate planning. But her emphasis is on health-related products. Feel free to e-mail Marge at the address below for future column questions. – Doni
Q: I was recently denied insurance coverage because my medical records showed I had “TIA” – but I didn’t. What do I do?
A: We have seen an increasing number of applicants have problems with underwriting due to coding on prior claims. Sometimes it is merely an error. Sometimes it is because the provider does not understand that “ruling out” a diagnosis and the actual diagnosis require different codes. In some cases, the provider is trying to help the person get an expense covered. Once that diagnosis is in the records, the only way it can be changed is through the provider. This would also require the original claim to be reprocessed and the explanation made in the chart and/or an addendum to the insurer.
It’s important to understand the long term implications of trying to use a diagnosis to “get something covered.” If there truly is no illness or injury, but the claims is coded as such, your future insurability could be impacted.
Q: My doctor says I’m fine, but the insurance company declined me for coverage. Why can’t they just accept my doctor’s judgement?
A: It’s important to understand that perspectives are quite different. Once the insurance company accepts you, they can not cancel your coverage. So, while you may be stable and controlled by your medication, that does not mean that you are an average risk or even a risk worth taking. The insurance company has a responsibility to its current policyholders to avoid “buying a claim.” An overweight diabetic may be controlled now, but there is no guarantee that he or she won’t become more obese and have more problems later. There is no guarantee that the medications they are taking won’t cause liver damage and further problems.
The best analogy I can give goes something like this: If you came to me to buy fire insurance, I would likely visit your home. If I found that you had a little fire in the corner, but you said to me, “Don’t worry, it’s all under control, we water it every day and keep the edges wet so it won’t spread,” it’s unlikely we would write fire insurance for you. After all, you might go out of town or a big wind might come up.
Insurance companies are in the business to manage risk. Unfortunately today’s individual health insurance market has gotten tighter. But don’t despair. There are other options, such as the HIPAA Guaranteed Issue pool or small group coverage, if you have a qualifying group of two or more employees. Most self-employed couples can make this type of coverage work and be eligible for guarantee issue coverage.
Margaret R. Beck owns and operates Affiliated Benefit Services at 1348 Market St., Suite 208 in Redding where she is a licensed CLU (chartered life underwriter), ChFC (chartered financial consultant) and CEBS (certified employee benefit specialist). She may be reached at (530) 225-8583 and mrb1348@gmail.com
