Under normal circumstances, insurance companies will not investigate the health information of the insured during underwriting, and the insured needs to tell the truth. Only when the claim is settled, the insured will authorize the insurance company to investigate.
There are two main forms of claims investigation by insurance companies. One is the insurance company's own claims investigation team; The other is to outsource the claim investigation to a professional investigation company. So the insurance company can definitely check the medical records.
Extended data:
According to the Medical Records Management Law of Medical Institutions:
1. Except for medical personnel who provide diagnosis and treatment services for patients and departments or personnel authorized by health and family planning administrative departments, administrative departments of traditional Chinese medicine or medical institutions to be responsible for medical record management, no other institution or individual may consult patients' medical records without authorization.
2. If other medical institutions and medical personnel need to consult and borrow medical records for scientific research and teaching, they shall apply to the medical institutions where patients are admitted, and can consult and borrow only after they have agreed and gone through the corresponding procedures.
It should be returned immediately after consultation, and the borrowed medical records should be returned within 3 working days. The medical records consulted shall not be taken away from the medical institutions where patients are admitted.
The investigation channels of insurance companies are as follows:
Generally speaking, insurance companies mainly know the past medical history of the insured in three ways: one is to inquire about medical records through social security or the new rural cooperative medical system; The second is the hospital treatment claim record; The third is the peer claim record.
First of all, insurance companies mainly obtain the medical records of the insured by investigating social security. Therefore, the medical records of social security and the new rural cooperative medical system are the top priority of the investigation.
The applicant lists in detail the medical records and records that the insurance company has the right to submit to any doctor, hospital, clinic, insurance company, medical examination institution, social security center, etc. Copy of their ID card or birth certificate of their children when applying for insurance or claim settlement.
At the same time, the social security card records the reimbursement and consumption in detail, including hospitalization information, outpatient information and drug purchase.
Baidu Encyclopedia-People's Republic of China (PRC) and China Insurance Law
Baidu Encyclopedia-Regulations on Medical Records Management of Medical Institutions