Notifying Insurance Company ?

[mizuno]

If you have gyne surgery do you have to tell your insurance company even if they don't cover it?
Say that you switch jobs and get new insurance thru your employer should you even mention that you had gyne surgery?
And one last point say you have complications with the surgery and have to go the emergency room or your regular physician
do you have to disclose that you had gyne surgery and more importantly will it be covered.
Thanks

[tttdone]

i dont think so man. if they aint gonna cover it, its none of their damn business.

[Dr. Elliot Jacobs]

If your insurance company does not cover your gyne surgery (and most of them do not cover it), then you are under no obligation to inform them about the surgery -- it is private and confidential. 

If you change jobs or change insurance, again, you are under no requirement to inform them.

Unfortunately, if you have complications from surgery, most often it will not be covered by your insurance if the original operation wasn't covered.  That is why choosing your surgeon is so very important -- an experienced gyne surgeon has very few complications.

Elliot Jacobs, MD, FACS

[mizuno]

If their are complications from surgery would the operating doctor be liable ?

[Dr. Elliot Jacobs]

Complications can occur with any surgery -- no matter how major or minor. There are no guarantees in surgery!!!

However, should a complication occur, your surgeon should be able to deal with it.  Part of surgical training is to learn how to do an operation well -- and how to deal with any complications should they occur.

Elliot Jacobs, MD, FACS

[trojan213]

I thought I read somewhere that if you don't disclose a preexisting condition or significant events in your medical history, it's grounds for having your policy terminated. Even if a policy doesn't cover a specific treatment, I believe you're supposed to disclose it?

Am I wrong?

[Grandpa Bambu]

I thought I read somewhere that if you don't disclose a preexisting condition or significant events in your medical history, it's grounds for having your policy terminated. Am I wrong?

Dude....   IC's are businesses. They are in business to make money, not loose it. So... when they ask you for your medical history, they are looking for things that would put them at risk of a major payout. Put yourself in their shoes... would you knowingly want to newly insure someone who could quite possibly cost you thousands, maybe hundreds of thousands of dollars? Of course you wouldn't....

Having said that, do you think that having GSR would put an IC at risk of a pay out? Don't think so... why would it? Also, having GSR is not a 'significant' medical event to an IC. To you, yes, but not to an IC...

GB

[headheldhigh01]

put another way, it's not life threatening.  life destroying in other senses, maybe, but they don't recognize that. 

it's not just that they don't cover it, it's why.  they claim it's not a true pathological condition.  so by their own argument, therefore, there IS nothing to disclose.  if they claimed differently, if they said it was worth attention, you could then go back and sue them for fraud for not covering the condition before.   

if they said it somehow increased your chances of some illness down the road, that would establish they were liable for refusing to cover it.  hello class action lawsuit. 

[mizuno]

Would you guys notify the insurance company's ?

[headheldhigh01]

only if i thought i had a strong chance of forcing them to cover it.  you have to read the fine print of your policy, they usually try to label it cosmetic.  there was a ruling against them in a new york court though that you could find with the site search engine.   

[Grandpa Bambu]

Would you guys notify the insurance company's ?

Notify the IC of what? That you have had GSR (Gynecomastic Surgical Reduction)?

GB

[trojan213]

I thought I read somewhere that if you don't disclose a preexisting condition or significant events in your medical history, it's grounds for having your policy terminated. Am I wrong?

Dude....   IC's are businesses. They are in business to make money, not loose it. So... when they ask you for your medical history, they are looking for things that would put them at risk of a major payout. Put yourself in their shoes... would you knowingly want to newly insure someone who could quite possibly cost you thousands, maybe hundreds of thousands of dollars? Of course you wouldn't....

Having said that, do you think that having GSR would put an IC at risk of a pay out? Don't think so... why would it? Also, having GSR is not a 'significant' medical event to an IC. To you, yes, but not to an IC...

GB

For what it's worth, my father built the first insurance claims processing software and was a senior executive at what is now CVS/Caremark...I've absorbed some stuff about insurance companies from him over the years and believe it's a little more complicated than that.

Insurance companies rely on the information that you disclose to them in deciding to extend coverage and calculate your premiums. They use algorithms with lots of inputs and the process is less than transparent.

If you fail to disclose pertinent information, it's called a material misrepresentation, and the insurance company can void your policy. All insurance companies clearly ask you to list any surgeries that you've had, including plastic surgery. Any type of surgery comes with health risks and potential complications that are of interest to insurance companies. Even small things that we overlook are often used in calculating your risk factor as a patient. Failure to disclose MIGHT put your policy at risk.

If you were to become a costly patient for whatever reason in the future, your insurance company may poke around, looking for ways to lose you. They may find a way to argue that your failure to disclose surgery when they CLEARLY ASKED FOR IT ON YOUR APPLICATION represents actual intent to deceive or increased risk of loss to the company. And if you get dropped, you're screwed.

So to answer another poster's question - I personally would disclose gynecomastia surgery on a new insurance application...I don't want to risk being uninsured in this country. If you are already covered, you probably don't need to notify your insurance company since once you have been approved, you then only need to disclose "material changes" to your health.

[Grandpa Bambu]

Failure to disclose MIGHT put your policy at risk.

So to answer another poster's question - I personally would disclose gynecomastia surgery on a new insurance application...I don't want to risk being uninsured in this country. If you are already covered, you probably don't need to notify your insurance company since once you have been approved, you then only need to disclose "material changes" to your health.

Yeah, you're right... It's best to be completely honest...

GB

[Grandpa Bambu]

Would you guys notify the insurance company's ?

What's the problem with notifying your IC anyways dude?

GB

[headheldhigh01]

the possibility that they might drop you like a hot rock? 

i believe in honesty as strongly as the next guy, but if they regard it as not a condition to be covered, then they can not legitimately claim it's a condition to disclose.  that simple.