If a person has a condition, say a torn rotator cuff, and they wanted insurance because they didn't have a ridiculous amount of money to repair the problem--after getting insurance (or before) and you were to go get your rotator cuff fixed, but you were denied of grounds of "pre-existing condition", how exactly do they know this information. Say a person had lied, and said on their insurance application, "nope, im perfectly healthy", how does insurance companies know if say, this person did go visit a doctor years ago, or had seen someone for their rotator cuff problem (pre-existing condition)...How do insurance companies find pre-existing conditions since all medical information is private--or is it...
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Your insurance company has the legal right to request and receive any medical records from your doctor that are relevant to processing your claims. I saw a guy get busted once because he applied for a policy stating that he had "no previous medical conditions," then ended up having a very expensive knee surgery within a month of when the policy began. When looking at the medical records, there were multiple notations about the knee issue from before he applied for his policy. The policy was declared invalid. (Since it was obtained via fradulent methods, it was as though the policy never existed.) The insurance company retracted all the payments from all the doctors, hospitals, etc. And the guy became liable for nearly $100K medical bills...all because he lied. (The sad thing is that disclosing the injury may not have prohibited him from getting coverage...he might have had to pay a higher premium, but it still would have cost him less than the $100K that he ended up owing.)
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