What is a medical history assessment?
A medical history assessment is a regulated review of your insurance policy to determine whether a medical condition existed before your coverage began. It is typically initiated when a submitted bill or treatment plan relates to a condition that may have existed prior to enrollment.
How does it affect your medical bills?
Payments for medical bills are generally placed on hold until the assessment is completed. You are responsible for providing all required information, including responses from your doctor or other third parties. Once a decision has been made and coverage remains in place, any payments that were on hold will be processed retroactively.
What are the steps?
Submit the required form
Complete and return the form sent to you. This usually includes:A confidentiality release authorizing Hallesche to contact your doctor
A questionnaire about your medical history
The team contacts relevant parties
After receiving your documents, the team will contact your doctor and/or previous insurer by mail. We recommend informing your doctor in advance to help avoid delays.Provide additional information (if needed)
In some cases, the team may request further details, such as an additional confidentiality release or clarifications about your medical history.Decision
Once all information has been reviewed, the team will make a decision, usually within four weeks.If no concerns are identified, any pending medical bills will be paid.
If the review identifies a contractual discrepancy, the team will inform you of the outcome and explain any resulting adjustments to your policy.
What are the possible outcomes?
Most assessments are resolved without issues. If relevant information was not disclosed, your policy may be adjusted (e.g., exclusions or surcharges). In rare and serious cases, the policy may be canceled.
What are your responsibilities?
Please ensure that all requested information is provided promptly, including coordinating responses from your doctor or other involved parties. Timely submission helps avoid delays in the assessment.