Sometimes clients ask us, "Can I choose which medical records the insurance company can access?"

In general, the answer is, "no, not if you want to qualify for insurance."

However, there are a few nuances worth explaining.

Before we dive in, here's a helpful word to know: underwriter. The underwriter is the person at the insurance carrier who reviews your application and decides if their company will offer you coverage and - if so - at what pricing level.

1) Mental health records 

A summary letter from your provider is typically sufficient. Full notes from all your visits are hardly ever required. 

While the underwriter technically has discretion to request what they feel is necessary to evaluate your application, full mental health records would be extraordinarily unusual.

2) Carriers have access to a fair bit of data withOUT your full medical records

As part of your application, you authorize the carrier to access information about your medical and lifestyle profile, including things like your prescription drug history, health insurance claims codes, your credit report, prior addresses where you have lived, etc.

You benefit when your application "matches up nicely" with what the underwriter will see anyway.

An underwriter who matches what they're seeing from third party sources with what you told them generally feels pretty good about your application.

Example (scene: an underwriter is sitting at her computer, reviewing your application, thinking to herself):

"Oh, I see Applicant Bob had a prescription for colonoscopy prep and a health insurance claim code for a colonoscopy three years ago, at age 37.

Hm, that is well before the age at which preventive care colonoscopies are typically recommended...

Ah, this make sense - now I see that Applicant Bob's mom had colon cancer at age 40, and she's still alive at age 70. So there's family history here.

And I also see that Applicant Bob told us in his questionnaire about that colonoscopy: his primary care physician referred him for a colonoscopy because he noted some gastrointestinal issues after a vacation, and the PCP was being cautious given the family history.

Applicant Bob said his colonoscopy was all clear. I see he gets physicals regularly, and there are no further prescriptions or claims codes related to gastrointestinal issues.

I like how what Applicant Bob is saying matches the prescription and health insurance claims codes I'm seeing. I'm going to approve his application now."

<end scene>

The above is what you want: a smooth process where the underwriter feels like things are lining up in a reasonable way.

3) Carriers don't really want to pull a bunch of your records "just for the heck of it" either

Whenever a carrier requests a medical record, the carrier has to spend money and time to get it.

Requesting your medical records from your primary care physician costs time and money. Requesting your records from the radiologist who does your scans will cost more time and money.

This means that carriers generally request records if they feel they are necessary, or they are required by company guidelines.

4) Insurance companies must follow the law when accessing your medical records

When you sign your application, it includes a HIPAA waiver (the form that allows the insurance company to access your medical records). The insurance carrier is bound by law to only use your information for the purpose of evaluating your insurance application.

Next Steps

A well-presented application frames you in the most favorable light truthfully possible, and facilitates a smoother experience for you and the carrier you are applying to.

Feel free to get in touch with your AboveBoard team if you are already applying and have questions. 

If you want to explore your options, get a quote for life insurance, disability insurance or long-term care insurance.