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Insurance screening is an evaluation of a prospective health or life insurance client to determine whether coverage should be extended and what kind of insurance should be offered. The screening is used by the insurance company to protect itself from obvious risks that could result in a high payout on the insurance policy. While many regions have laws prohibiting discrimination on the basis of disease, disability, and genetics, insurance companies are not violating the law, as the screening is integral to the services they provide.
In an insurance screening, a patient will usually be interviewed and asked to disclose any and all known medical history and risks. In addition, the insurance company may ask for access to medical records and can request medical testing, such as blood and urine testing. All of this information is used by the insurance company to identify risks that could complicate the person's insurance policy.
Eligibility screening determines whether the insurance company can offer coverage at all and what type of coverage it can reasonably provide. Usually certain histories exclude people from coverage because the risks for the insurer are too high. Insurers can also limit coverage or develop a custom contact excluding coverage for certain issues in response to the results of the screening. A patient may be advised that a policy will not cover certain conditions or medications due to risks.
It is possible to contest insurance screening results if they appear biased or unfair. Patients may argue that testing was faulty or that information is skewed in nature. Appeals can be filed with the insurance company to ask for another review or to provide additional documentation that may clarify a situation. Insurance agents can help people with this process; agents can often turn out to be useful allies because their goal is to sell insurance, and thus they want to make sure that all insurance applicants are provided with access to plans that meet their needs.
People can decline insurance screening, but the insurance company can choose not to cover them or to offer limited options in terms of insurance coverage. It is possible to request pre-screening from a doctor who is familiar with the insurance screening process. This can be used to determine whether a person is likely to be eligible for coverage before the person goes through the process of applying for coverage, undergoing screening, and reviewing quotes on various insurance policies.