What is a Medical Underwriter?

Mitch Morgan
Mitch Morgan

A medical underwriter determines whether or not an applicant should be granted medical coverage based on the patient's current or pre-existing medical conditions. Having evaluated the health of an applicant, a medical underwriter may then either accept or deny insurance coverage for the individual and, if the applicant is accepted, may then determine what premium rate to set for that particular client, based on the financial risk that entails accepting the applicant. Although it was created for the purpose of lowering insurance premiums for individuals, the practice of medical underwriting may be considered a harsh practice by some who are denied coverage based on a minor condition. Insurers, however, may argue that the practice prohibits individuals from seeking coverage strictly when surgery or other expensive medical procedures are needed.

Obesity is a medical condition that may result in a medical underwriter denying coverage.
Obesity is a medical condition that may result in a medical underwriter denying coverage.

Some insurers may claim that by making some applicants ineligible, the return investment of insurance premiums is leveraged, helping make these premiums more affordable for the masses, and helping ensure some monetary return for the insurer. Due to the negative reception of medical underwriting by some individuals in the United States, the practice has been restricted by law in certain states, and within some insurance companies. In turn, these states generally maintain the highest average premiums in the country. While it may be argued that outlawing medical underwriting allows otherwise uninsurable applicants to receive some coverage, insurers often claim that dismissing the practice would raise premiums even further, and prevent even those healthy individuals with no pre-existing conditions from being able to afford insurance or medical coverage.

A medical underwriter must have excellent computer and research skills.
A medical underwriter must have excellent computer and research skills.

Some medical conditions that may result in a medical underwriter denying coverage to an individual may include more serious illnesses such as heart disease, arthritis, and most cancers. Less-serious and often curable conditions such as obesity, anorexia, and old injuries may likewise prevent certain individuals from being accepted by an insurer. The set of criteria taken into account by a medical underwriter may vary depending on the insurance provider, or the state or region in which the applicant resides. Millions of individuals living in the U.S. are currently considered uninsurable due to some pre-existing condition that may or may not be severe enough to warrant the denial of a premium. This concern continues to spark debate across the country.

A medical underwriter determines if an applicant should be granted medical coverage based on pre-existing medical conditions.
A medical underwriter determines if an applicant should be granted medical coverage based on pre-existing medical conditions.
A medical underwriter may work in a hospital setting.
A medical underwriter may work in a hospital setting.
A medical underwriter is responsible for performing insurance application evaluations.
A medical underwriter is responsible for performing insurance application evaluations.
Obtaining an administrative position in a health services field may help prepare an individual for future work as a medical underwriter.
Obtaining an administrative position in a health services field may help prepare an individual for future work as a medical underwriter.
Mitch Morgan
Mitch Morgan

Mitch is a journalist, photographer, and test administrator who has contributed to a diverse array of publications, including the Oxford, Mississippi arts and entertainment guide Oxford Town and the trade publication Nightclub & Bar Magazine. In addition to his freelance work for wiseGEEK and several other websites, Mitch has written dozens of album reviews, allowing him to showcase his love of music and media.

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