L.E. asks from Irvine, CA on April 25, 2009
Rejected by Health Insurance Company. Now What?
I am the mother of two children ages 2 and 1. My husband is a self-employed musician programmer; I am a graduate psychology student who will graduate in 2+ years. As such, neither my husband nor I is eligible for company-sponsored health insurance coverage. My COBRA ends May 31st, so I need to act quickly to avoid a break in coverage.
I just received a letter from Blue Cross/Blue Shield informing me that the company would not insure us. I never thought that my family would be turned down because I had accepted nasal spray, which is available over the counter, from an allergist that told me I was allergic to dog dander. (I don't own a dog. I have walked, played with and bathed dogs in the past, esp. a dozen years ago when I worked as a volunteer at an animal shelter. Dog dander does not rule my life!) I wish that I hadn't gone to the allergist. The only reason I went was because I felt slightly tired. The fatigue was probably a result of taking care of two babies and attending school--not an allergic reaction to dog dander!
I am concerned that other health insurance companies will reject us, especially now that one has recently rejected us--at least for plans that don't require clients to pay an exorbitant fee. I am concerned that the exorbitant fees (over $1,000 per month) required of clients in high-risk pools will nearly bankrupt us. I always thought of HIPAA high-risk plans as plans for people who had serious, chronic, potentially life threatening or disabling diseases such as brain cancer or diabetes or had had serious operations such as quintuple bypasses, not people who were slightly allergic to dog dander or had accepted Accutane from a doctor to treat acne. (One of my husband's friends was rejected by an insurance company because his daughter was prescribed Accutane--at least that's the reason the insurance company gave.) I am afraid to live without insurance coverage because we risk bankruptcy if an unusual or severe event or development occurs. Although my family cannot pay for treatment of a serious chronic medical condition or accident, my family is "too rich" to qualify for health care programs geared for low-income families (Medicare, Medicaid, Healthy Families, etc.)
I don't think that applying to high-deductible or catastrophic plans will help my family as the people who manage those plans base who they accept or reject on the same criteria as people who manage the low-deductible plans. Beside, the plan that Blue Cross/Blue Shield told my family we could not get was a high-deductible plan.
I know several people who have lied/withheld information on their insurance applications and gotten insurance coverage. I know someone who even withheld the fact that she had polycystic ovarian syndrom (PCOS) and, by doing so, got insurance coverage. I completed all my forms accurately and thoroughly. I value honesty, but I'm starting to think that honesty doesn't pay.
My mother-in-law suggested I write to my congressman/woman, but I don't think that he or she will be able to significantly help me fix my problem within five weeks--even if he or she is a compassionate, intelligent person.
How can I get my family covered in the next FIVE WEEKS without breaking the bank or breaking the law?
1 mom found this helpful
So What Happened?™
Thank you for all your ideas. In an effort to convince Blue Shield to accept me as a client,I asked a couple of my doctors to write letters to Blue Shield describing the diagnoses, treatments and outcomes that Blue Shield said disqualified me. I also confirmed that my family is eligible for Cal-COBRA, which does not run out until December 2010. Starting in August 2009, my family is also eligible for insurance coverage through Anthem Blue Cross as a part of my university's pool. No underwriting is done in this type of program, so my family will not be disqualified for medical reasons. I'm relieved that I can get affordable insurance for at least another couple of years. Ideally, by the time I've finished school, I will have found a job in which the employee is eligible for health insurance benefits, as well as retirement benefits.
D.M. answers from Los Angeles on April 26, 2009
I'd try Kaiser as well. Our whole family has been covered by Kaiser for at least 30 years, and for the most part, the doctors and services have been great. They do all the testing they need to do without balking about it, if they can't diagnose something they bring in people who will (my son was diagnosed with juvenile rheumatoid arthritis about 20 years ago; they couldn't figure it out so brought in a specialist from Children's Hospital who diagnosed him in a single visit, which Kaiser paid for), and I love my personal care physician and the doctor who was my children's pediatrician when they were under 18.
I started a sole proprietorship a couple of years back, and got several marketing pieces from Kaiser inviting me to apply for coverage. (Didn't need it, because we're covered through my husband's employer.) As someone else suggested, check with any associations to which you belong that might provide the option of a group health plan.
Best of luck--this is a huge issue, and it must be bearing very heavily on you.
E.Z. answers from Los Angeles on April 25, 2009
Well, you don't say if your current COBRA is with Blue Cross/Blue Shield? If not, I'd try to get continued coverage within the same company that now carries your COBRA. You'd be their excisting client, just go on another plan.
If not, then next time you fill out an application - remember that medical history usually is only important if it's "recent", some companies say 3 years back, some 5...
You might need to go through a Insurance Agent that know about certain requirements for different companies.
I don't know what state you are in, but if you are in California, then you might at least qualify for state sponsored insurance for the children through Healthy Families.
C.M. answers from Los Angeles on May 07, 2009
Hi L.. I had the same problem when my COBRA ran out. I've had Kaiser most of my life and love it. They denied us for an individual plan primarily because we had been treated for various things in the past five years. On the advise of a friend in the insurance business, I applied as a business with two "employees", my husband and I. My husband is a self employed concrete contractor. I pay all our bills. On paper I am the office manager working (supposedly) 30 hours a week for him. As long as the two of you file a joint income tax return you don't need to provide an EDD report. Kaiser approved us right away as a business. My kids are on healthy families (for working, low income people making up to approx. $43K per year). They have a much better Kaiser plan than we do but that's all we can afford.
Good luck! It's a pain to have to deal with all this. Universal health care would certainly help.
B.L. answers from Los Angeles on April 26, 2009
My husband and I went through he same thing. It seems impossible to get insurance these days, but there definitely are ways to do it:
- Check out any and all associations that you or your husband can join. I'm in the field of graphic arts, and one of the graphic arts associations had a group insurance plan that we were able to join a few years back. They took us when I was 4 months pregnant, so they didn't have strict pre-existing guidelines.
- See if your husband could create a partnership with any of his fellow musicians. By creating a small company with more than 2 employees, you would be eligible for group insurance.
- If you really can't get insurance for you or your husband, contact your local school district and ask them about insurance for children. There are inexpensive programs that will cover your kids.
- You you're in California, you can call my insurance agent. Not sure he can help you, but he was the one who helped us set up our company so we were eligible for small group insurance. His name is Steve Holtz, ###-###-####.
I've been down the same path and I know it's a huge struggle. It's a big problem in our country. Hopefully the current administration will do something to fix it.
L.M. answers from Los Angeles on April 26, 2009
I would try joining some organizations that offer plans, i.e. American Association of College Women, etc. I would ask if they have pre-existing condition requirements or if they treat their group as in employer would--accepting all patients. Since you are in school, you might qualify for county insurance for your children. They have an HMO Plan. Check out this website: www.first5la.org/Programs/Healthy-Kids and you can call to determine if you qualify. You might also look to the musician's guild to see if they have any connections/plans. That's all I could come up with off of the top of my head. Good luck!
T.F. answers from Los Angeles on April 26, 2009
Try Kaiser. They seem to be a little more reasonable about things. I had taken blood thinners as a precaution during my pregnancy (have the propensity for clots - Factor V Leiden - but have never had a clot). Blue Cross wants me to be free of blood thinners with no clots for 10 years. As a result, my family is on Blue Cross and I am on Kaiser. I actually think Kaiser is great insurance, I have had really good luck with great doctors! Hope that helps some :)
E.G. answers from Los Angeles on April 26, 2009
I soooo feel your pain! I am a small business owner and my husband and I were both rejected from multiple insurance companies. Are you running out of your CAL-Cobra or just the original Cobra? We are relatively new to CA and were not aware there was such a thing as CAL-Cobra, so now we have until May 2010 until that runs out and hope there is healthcare reform by then.
In the mean time if you already have the CAL-Cobra, shop, shop, shop around for other HIPAA plans. If I remember right when I was shopping Healthnet had the best prices with half way decent coverage.
What ever you do, do NOT let your coverage lapse and do NOT lie! Insurance companies will find ANY reason not to cover something and if you lie I guarntee, they will drop you!
I wish you luck!!!
A.T. answers from Los Angeles on April 26, 2009
The advice already given has been great. I would also suggest that you call or write the allergist you saw explaining the situation. He/she can write a letter to the insurance company describing how mild your symptoms are/were and may be able to get it to no longer be listed as a "pre-existing condition". After all, who doesn't get mild allergy symptoms these days? If the insurance company realizes that this allergy isn't going to cost them any money in the future, then they have no reason to hold it against you. Good luck!