Insurability of pediatric gastrointestinal disorders
Related Experiment Videos
1Division of Gastroenterology and Nutrition, Childrens Hospital of Los Angeles, CA 90027.
Insights
Most health insurance companies find pediatric gastrointestinal disorders uninsurable or insurable at higher rates. Accurate medical records are crucial for assessing insurability, with many companies encouraging reapplications later.
Area of Science:
- Pediatric Gastroenterology
- Health Insurance Underwriting
Background:
- Assessing health insurance eligibility for children with gastrointestinal disorders presents challenges.
- Understanding insurance company practices is vital for families seeking coverage.
Purpose of the Study:
- To evaluate the insurability of children diagnosed with gastrointestinal disorders.
- To understand how health insurance companies handle applications for these children.
Main Methods:
- A questionnaire survey was distributed to 106 health insurance companies.
- The survey focused on the companies' procedures for insuring children with gastrointestinal disorders.
Main Results:
- Only 24% of companies responded, with just 9% completing the questionnaire.
- Insurability is typically determined by medical record review, with variable responses for specific conditions.
- Most pediatric gastrointestinal disorders are deemed uninsurable or insurable at increased rates.
Conclusions:
- Accurate and detailed medical records are essential for insurance application review.
- There is a need for greater education within the insurance industry regarding pediatric gastrointestinal disorders.
- Families should be aware that many pediatric gastrointestinal conditions face insurability challenges.
Abstract:
To assess the insurability of children with gastrointestinal disorders, the authors surveyed by questionnaire 106 health-insurance companies concerning their handling of an application for health insurance for a child with a diagnosed gastrointestinal disorder. They received 24 responses (23%) of which only ten companies (42% of the respondents, 9% of the companies surveyed) completed the questionnaire. Insurance companies generally were not receptive to their inquires. The consensus of the responses was that ultimate insurability is dependent upon review of the medical record. For individual gastrointestinal diseases, responses were variable and often not easily categorized. Many companies encourage applicants previously denied coverage to reapply at a later date. Most pediatric gastrointestinal disorders are not insurable or insurable only at increased rates. Since insurability is dependent upon review of the medical record, the medical record must reflect the diagnosis and prognosis accurately. Education of the insurance industry regarding pediatric gastrointestinal disorders is encouraged.