Headline.
In essence, I’m looking to enroll my family in some real, reasonably priced insurance. My broker advises me not to disclose the fact that I now have mild UC because United Healthcare might refuse to cover me. Broker says I can still have office visits with my UC doctor, but I can’t have any UC-related surgery for the first year. After that, I should be fine to go. Does anyone find this strange? Do I need to worry?
I understand that ACA-compliant plans can be more expensive if you don’t qualify for a subsidy, but there’s a good reason for it. Non-ACA-compliant plans often exclude many things, including pre-existing conditions, and they’ll likely find a way to avoid covering you or cancel your policy once they discover your UC.
The broker is primarily interested in their commission.
It’s best to purchase a plan from Healthcare.gov, even if it comes at a higher cost.
Your broker is urging you to commit insurance fraud. Shouldn’t that worry you?
Your plan probably won’t cover any office visits to your UC doctor, as normal, healthy individuals don’t visit specialists without reason. What if your UC worsens and requires surgery within the next 12 months? What will you do then?
Providing false information on an application for a “medically underwritten” health insurance policy constitutes fraud.
If you submit a significant claim, regardless of whether it pertains to a pre-existing condition, the insurer will scrutinize your medical history extensively and may cancel your policy due to fraud.
It appears you are dealing with an unethical broker. Engaging with such a person is ill-advised, as their deceitful practices indicate a willingness to exploit others for financial gain; selling you an inappropriate policy to earn their commission.
With Open Enrollment starting in November, you have the opportunity to obtain insurance honestly, without misrepresenting pre-existing conditions or dealing with dubious policies from unscrupulous brokers.
As the saying goes, “You can’t cheat an honest man (or woman).”
Red Flag. If a broker or agent advises you to be dishonest on an application, it’s a definite NO.
Not only do you risk having your claims denied (and not just initially; they can claw back approvals even years later), but you also risk facing a felony fraud charge.
Since this plan is medically underwritten, it’s not an ACA Plan, and pre-existing conditions can be excluded. Non-ACA plans have entire departments dedicated to finding ways not to pay.
Avoid doing business with this broker; they are clearly unethical.