How to get disability insurance without exclusions that don't make sense?

[gmoneyjive]

What is the name of your state (only U.S. law)? Colorado

Hi,

First off, sorry if this is too long. I've been fighting this for two months and am really struggling. If you don't have much time but could skip down and answer any of the questions at the bottom off the top of your head I'd appreciate it; I don't want to make too much work for anyone.

I recently applied for disability insurance through Principal. I went through the short phone interview but was so exhausted I left a few things out. They came back and said there were some prescriptions I didn't mention, and after talking with my doc we guessed the only ones on record here in Colorado are narcotics like Percocet (taken after hernia & once in a while when I tweak my back), Xanax (had a script since '03 but hardly take it as I don't have attacks anymore), and Adderall (have mildish ADHD, but take it when I’m overbooked and have deadlines with consequences) as they are required to be reported to the Prescription Drug Monitoring Program (PDMP - later I would find out PDMP doesn’t release any info). So I gave them those and explained the situation in the best way possible (Percocet & Xanax rare, which is true, and we said Xanax was only for high pressure situations like public speaking or when I really couldn't fall asleep), and Adderall to help concentrate but not every day and I've gone months without it. They requested med records from my doc, and I told him I only wanted to release certain info, which he agreed to.

They came back and said the doc had left out some records, and after a while of trying unsuccessfully to get them they offered a policy, but with a few exclusions. Some of them made sense (back pain), but some did not (depression). Considering I’ll be paying thousands of dollars over the years I would like to avoid as many exclusions as possible, especially ones that don’t make sense. So, Principal is a no-go, next up is Guardian and a few others, but I want to make sure I give myself the best possible chance of getting a policy before applying elsewhere.

But all this got me wondering: where are they getting their info, and wasn’t HIPAA supposed to protect my information? I started with my doctor, pharmacy and insurance company, all who denied sharing information. I opted out of Electronic Health Records (EHR), said I thought my identity may have been stolen and froze/password protected or otherwise locked down and prevented release of info there.

I then found out they requested info from MIB (formerly Medical Information Bureau - they keep a database of medical information and provide risk analysis for underwriters), so I got my disclosure and they had nothing on me. That started a two-month long dive down the rabbit hole of Specialty Consumer Reporting Agencies (CRAs), especially the medical ones such as Intelliscript, ExamOne (Scriptcheck, formerly OptumInsight/MedPoint/Ingenix), along with dozens of other CRAs. They apparently get their info from Pharmacy Benefit Managers (PBMs) and data clearinghouses. Thus far only Intelliscript has had info on me, and they have everything. I’ve been researching ways to lock that data down, but there doesn’t appear to be a way unless you know of one. I’ve gotten disclosure from everywhere possible until I ran out of gas and asked to opt out/freeze/password protect or otherwise prevent release of medical info to varying degrees of success. Some have come back asking for a police report and other things, but I fear if I lock everything down - if that’s even possible - it’ll prevent me from getting disability insurance. I’ve also heard of medical information data miners/brokers such as SAS Business Analytics and Insurity Inc., but haven’t gotten that far yet.

Sorry for the long email, but if you have quick answers to the following questions - or at least some off the top of your head as I don’t want to make extra work for you - please let me know:

1. Is there any point in trying to track down the rest of the data clearinghouses, medical information data miners/brokers to get disclosure, opt out, freeze, etc. information or is a) what’s already out there is out there, and b) would I be doing more harm than good by trying to limit a disability underwriter’s access to information, especially if they found out that’s what I’m trying to do?
2. Is there any way to prevent disability insurance underwriters from getting this information, or at least some of it? Especially Intelliscript.
3. If I freeze medical Data, will I be denied?
4. I’m guessing there’s no point in filing a HIPAA complaint, correct?
5. Would applying for lower payouts vs. max aka a “middle of the road plan” would make them less inclined to dig up everything about me? Logic says it should, but I’m not sure it works that way.
6. Would applying for both life & disability would help raise less red flags as that seems more like someone taking care of future family vs. quickly cashing out on a policy… thoughts? For what it’s worth on the last two questions, only Intelliscript had info on me (and they had everything), MIB & ExamOne didn’t have anything. Or so they claimed.
7. Know of any plans (Fed Advantage?) that won’t dig too deep into underwriting and won’t have exclusions?
8. Will it hurt me to apply for a bunch at once like I’ve heard with life insurance? I came across a story where a guy had applied for ~130ish life policies and received something like 80 of them then killed himself - it was on one of the CRA’s sites about the importance of underwriting as the ~50 insurers that did proper underwriting didn’t’ get screwed like the rest. However, it seems this isn’t the case with disability. I can also use one of the dozens of brokers and apply everywhere at once, saying I’m going to pick the best one.

Any help you can provide would be greatly appreciated!

 

[FlyingRon]

This is not a legal question. Try an insurance forum.

Frankly, you left them no question other than to infer that you have existing back and depression issues based on the information you did allow them to have.
Disability insurance is not covered by the ACA. They're under no obligation, and in fact are economically disinclined, to issue policies for people who have potentially disabling conditions.

 

[adjusterjack]

But all this got me wondering: where are they getting their info,

When you apply for disability insurance, whether it be on paper or electronically, you list your medical providers and your health conditions and you EXPRESSLY authorize the insurance company to obtain records from ANYWHERE.

and wasn’t HIPAA supposed to protect my information?

No. Not when you EXPRESSLY authorize the release of your information.

I started with my doctor, pharmacy and insurance company, all who denied sharing information.

It's possible that a request for records went in a different door and was handled by people other than those you talked to. At any rate, as you have probably figured out, there are many more sources of medical information on you.

I opted out of Electronic Health Records (EHR), said I thought my identity may have been stolen and froze/password protected or otherwise locked down and prevented release of info there.

Your EXPRESS authorization trumps any of that.

They requested med records from my doc, and I told him I only wanted to release certain info, which he agreed to.

You "told" your doc?

"Telling" him doesn't do anything. Did you put it in writing and get it to his medical records clerk? If not, then the clerk had no choice but to release any records requested by the insurance company.

I’ve been researching ways to lock that data down, but there doesn’t appear to be a way unless you know of one.

There is no way of "locking it down."

I'll cut to the chase now.

If you want insurance you authorize the release of all your records for the insurance company to review.

If you aren't willing to do that, you go without the insurance.

It's that simple.

I'll answer the rest of your questions because they amuse me.

1. Is there any point in trying to track down the rest of the data clearinghouses, medical information data miners/brokers to get disclosure, opt out, freeze, etc. information or is a) what’s already out there is out there,

No. Not with regard to applying for insurance. The insurance company has a right to the information.

and b) would I be doing more harm than good by trying to limit a disability underwriter’s access to information, especially if they found out that’s what I’m trying to do?

I don't know what you mean by harm. You just won't get the insurance if you try any hanky panky. Insurance companies have been around for hundreds of years and are a lot smarter than you are.

I used to investigate life and disability claims. We, who do that, are highly trained to look under every rock. Even if you are somehow successful in getting a policy, the insurance policy has a two year constestability provision. If you become disabled within two years of issue and the company finds you misrepresented or concealed something, the claim gets denied and the policy rescinded.

2. Is there any way to prevent disability insurance underwriters from getting this information, or at least some of it? Especially Intelliscript.

Not that I know of. But even if there is, you risk not getting the policy, or losing it after you get it.

3. If I freeze medical Data, will I be denied?

Yes.

4. I’m guessing there’s no point in filing a HIPAA complaint, correct?

Correct.

5. Would applying for lower payouts vs. max aka a “middle of the road plan” would make them less inclined to dig up everything about me? Logic says it should, but I’m not sure it works that way.

There are insurance companies that write disability policies with no medical underwriting. The policies generally cost more, have low benefits, and a waiting period before you can collect.

6. Would applying for both life & disability would help raise less red flags as that seems more like someone taking care of future family vs. quickly cashing out on a policy… thoughts? For what it’s worth on the last two questions, only Intelliscript had info on me (and they had everything), MIB & ExamOne didn’t have anything. Or so they claimed.

Each policy is underwritten on its own merits. Applying for life and disability at the same time result in more income to the agent but does nothing for you.

7. Know of any plans (Fed Advantage?) that won’t dig too deep into underwriting and won’t have exclusions?

The are either medically underwritten or not medically underwritten. There is no in between. Though there are policies that can be written without exclusions but you will pay a lot more for them.

8. Will it hurt me to apply for a bunch at once like I’ve heard with life insurance? I came across a story where a guy had applied for ~130ish life policies and received something like 80 of them then killed himself - it was on one of the CRA’s sites about the importance of underwriting as the ~50 insurers that did proper underwriting didn’t’ get screwed like the rest. However, it seems this isn’t the case with disability. I can also use one of the dozens of brokers and apply everywhere at once, saying I’m going to pick the best one.

I doubt if any of those insurance companies had to pay out if the guy killed himself within the two year contestability/suicide period, if the story is even true at all. When you apply for life or disability insurance there is invariably a question about whether you have other insurance or are applying for other insurance and if you lie on an insurance application you also risk losing the insurance due to "misrepresentation, concealment, or fraud" a provision that exists in every insurance policy.

If you are successful in taking out multiple policies and are willing to pay the premiums for two years before making a claim, go for it.

 

[gmoneyjive]

I don't have depression or even anxiety anymore which is the reason I was asking, and no I'm not looking to take out more than one policy. I'd just read that story (true or not) and really just wanted to go to a broker or two to apply everywhere and was wondering if that would raise red flags even though I won't get more than one policy. Sorry for posting in the wrong forum, and thank you for your responses.

 

[adjusterjack]

You're actually in the right forum for insurance questions.

Google "guaranteed issue disability insurance."

Look for insurance companies that write it that way. You won't have to submit to medical underwriting and there won't be any exclusions for pre-existing conditions.

You'll pay more for the insurance and there may be limitations on the amount and the duration of benefits but it's out there.