private health insurance form AS disclosure... HELP

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Penelope_asparagus
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29 Feb 2012, 9:20 pm

My friend just moved here from another country where he had some supportive living help because he was in school and it fell under "school services". They don't use the DSM there, so he isn't coded under that, but under whatever they use in Europe. I think HFA is the official diagnosis. Anyway, he needs health insurance.

So we're sitting here filling out a private health insurance form (self-employed, only option right now), and one of the questions is if:

"in the past 5 years, have you been diagnosed with or sought or received any professional consultation or treatment (including prescription medications) from a licensed health practitioner for any of the following?"

and one of the items in the list is "autism"
not "AS" or "HFA"... "autism"

So either we answer "yes" or "not sure", and they ask for all of his records, translated. And reject him? Or charge more? And have it on his record here? Or we answer "no" and hope nothing serious happens that they look for a reason to rescind him? What to do?

He's in perfect health and doesn't need any services now. He only had them before because he was in school.
I'm not even sure if he has any way of getting his records...



dr01dguy
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29 Feb 2012, 9:55 pm

They'll probably treat it the way BlueCrossBlueShield treats ADHD... they won't increase the premium, but they'll exclude anything and everything related to "cognitive disorders" from coverage for the life of the policy.


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questor
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29 Feb 2012, 10:14 pm

Your friend is on the autism spectrum, so the correct answer on the form would be yes. However, they are not likely to cover him at all, or definitely not for that pre-existing condition once they know of it. On the other hand, if he does not tell the truth on the form, and they find out later that he lied, then they will cancel his coverage with them. Any other insurance companies he tries to get coverage with after lying to that one will probably refuse to cover him.

So your friend is between a rock and a hard place, and in a catch-22 situation. Tell the truth and either get no coverage at all, or not have that condition covered, either way will have to pay a higher premium. Don't tell the truth, and risk loss of coverage, and reduce chance of getting on other policies in the future. The company may also be able to charge your friend with fraud for filing a false application, but would probably just settle for dumping him, as it is cheaper and simpler than a court case.

Since your friend's records are in another language, and in another country, and he is just recently out of school, he may be able to get away with keeping quiet about his condition, as long as he doesn't need any doctoring for it now.


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Penelope_asparagus
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01 Mar 2012, 9:08 pm

Thanks for the answers so far. I think he'll say "no". His actual diagnosis was more than 5 years ago. The supportive services I mentioned were just somebody coming by and checking up on him weekly. He doesn't think that would have been a psychologist or anything. And I can't figure out any way to put that on the form that doesn't bring in everything else: i.e. have them ask for all of his records (supposing they all exist still...)