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Can mistakes in your medical record raise your insurance premiums?

Michele Lerner

Your doctor’s terrible handwriting may seem harmless, but a scribbled notation can lead an insurance company to believe that you have diabetes or untreated high blood pressure. One mistake in your medical record can prevent you from getting insurance coverage or can cause you to pay higher premiums.

Even though the majority of doctors now use electronic record-keeping systems, that doesn’t mean your medical record is immune from errors.

medical record“People don’t realize that doctors are listening and writing down everything that they say,” says Joshua Lavine, president of Capitol Benefits, a Washington, D.C. insurance and financial services broker. For example, Lavine says, “If you have a conversation about your favorite wine, the doctor could note in the file to monitor for alcohol abuse.”

The impact of a mistake in your medical record depends on the amount of insurance you’re requesting and the type, says Dr. Steven Weisbart, senior vice president and chief economist of the Insurance Information Institute in New York City.

Decisions about how much to charge or whether to approve an insurance policy depend on how likely the insurance provider thinks they will have to pay a claim and how large the insurance benefit will be. If you’re requesting a larger insurance policy, the insurance company will likely do their own testing and request a physical exam rather than relying only on your medical records, Weisbart says.

3 types of insurance that may be affected by your medical record

Here are 3 types of insurance where your medical record may affect the premium you’ll pay.

1. Life insurance

Life insurance rates are typically based on health issues including smoking, drinking and your height and weight, Lavine says.

Your premiums could be higher or your insurance application could be denied if you have a mistake in your medical record related to a disease that could lead to an early death or physical problems, such as diabetes or a heart condition. If your doctor forgets to list medications you’re taking to control the condition, it may appear that you aren’t managing your illness.

2. Long-term care insurance

Lavine says that notes in your medical record about physical impairments could negatively impact your ability to get both long-term care insurance. For example, Weisbart says a family history of osteoporosis could raise your premiums or prevent you from getting insurance. A family history of mental problems associated with aging could also raise your rates or cause an insurance policy denial.

However, according to Weisbart, most long-term benefits are paid out for mental conditions such as Alzheimer’s disease and dementia – and signs of these conditions typically won’t show up on your medical record.

3. Disability insurance

When deciding whether to approve you for a disability insurance policy, “the insurance company will look for risks that indicate you might not be able to perform your job, so what they’re looking for depends on your career,” Weisbart says.

For example, if your medical record shows an old spine injury that never actually happened, then that would have potentially have a bigger impact on your premium if you’re a UPS delivery person than if you’re an accountant.

How to correct your medical record

If you receive a rate increase or denial from an insurance company, your first step should be to find out what the reason was and then discuss it with your doctor, Lavine says.

The Health Insurance Portability and Accountability Act (HIPAA) allows you to request your medical records and ask your doctor to amend them if they’re incorrect or incomplete. According to the Department of Health and Human Services, if the provider doesn’t agree to your request, you have the right to submit a statement of disagreement that must be added to your record. An insurance company would see the statement when requesting your records and could decide to investigate your health condition further with a physical exam or testing.

“You should deal with your medical records like you deal with your credit score,” Weisbart says. “You need to find the source of the error and marshal evidence to try to get the original source to change its record.”

Depending on the type of mistake made, you can look for a relative’s medical records or your own lab test results or pharmacy records to correct a mistake. For example, if your doctor erroneously noted a family history of heart attacks and your medical record doesn’t reflect any action taken on your part to prevent heart trouble, an insurance company could consider you a high risk applicant.

Your healthcare providers store your medical records and, if you’ve applied for an insurance policy, information about your medical records is also kept on file by MIB, the insurance records database formerly known as the Medical Information Bureau. If you find an error in your medical records, you’ll need to correct it with MIB as well as your doctor.

MIB doesn’t keep your actual medical records or complete details about your medical condition, but instead keeps codes in its database that represent conditions mentioned by your doctor in your records that are significant to how long you may live.

According to David Aronson, a MIB spokesman in Braintree, Mass., consumers can request a free copy of their MIB report once per year.

“Out of all the free files we provide to consumers, only 1.2 percent have to be amended due to inaccurate or incomplete information,” Aronson says.

If you request a correction to your MIB file, MIB will investigate the complaint with your health care provider and then amend the file or keep a statement of dispute in the file. MIB files are kept for seven years after each time you complete an insurance application.

Reviewing your medical records regularly and your MIB report annually can prevent a mistake from sending your insurance rates up or an insurance policy denial.

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