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Do I need to be examined by a doctor for health insurance?

On Behalf of | Aug 9, 2023 | Insurance

If you are looking for health insurance in Oklahoma, you may wonder if you need to be examined by a doctor before you can enroll in a plan. The answer depends on the type of health insurance you are seeking and your health status.

Oklahoma law

According to the Oklahoma Insurance Department, there are three main types of health insurance: traditional health insurance, managed care services and limited benefits insurance.

Traditional health insurance, also known as fee-for-service, allows you to use any doctor or hospital and submit your bills to the insurance company. However, this type of plan is rare and mostly found in grandfathered plans that are not compliant with the Affordable Care Act or in Medicare Supplement Plans. Most ACA-compliant plans are comprehensive medical policies that pay a percentage of covered expenses after you pay a deductible and copays.

Managed care

Managed care services are plans that contract with a network of providers to offer health care services at lower costs. These include Health Maintenance Organizations, Preferred Provider Organizations, Exclusive Provider Organizations and Point of Service plans.

With these plans, you may have to choose a primary care provider who coordinates your care and refers you to specialists when needed. You may also have to pay more or get prior authorization if you use out-of-network providers.

Limited benefits

Limited benefits are plans that only cover certain types of services or have low benefit limits. These include short-term health plans, fixed indemnity plans, accident-only plans and critical illness plans. These plans are not regulated by the ACA and do not have to cover essential health benefits or pre-existing conditions.

Doctor examination

So, do you need to be examined by a doctor for any of these types of health insurance? The answer is no, if you are enrolling in an ACA-compliant plan or a government plan such as SoonerCare (Oklahoma Medicaid), Medicare or VA.

These plans do not require medical exams or ask about your health history when you apply. They also cannot deny you coverage or charge you more based on your health status.

However, the answer may be yes, if you are applying for a non-ACA-compliant plan, such as a short-term health plan or a fixed indemnity plan. These plans may require you to answer health questions or undergo a medical exam before they accept you. They may also exclude or limit coverage for pre-existing conditions or charge you higher premiums based on your health status.