Daughter Denied Health Insurance, Seeking Urgent Advice

Updated on December 17, 2010
E.E. asks from Los Angeles, CA
12 answers

We are in the process of applying for new insurance as ours expires at the end of the year. My husband and I have been approved but my daughter (22 months) has been declined due to needing minor surgery three months ago for a MRSA infected diaper rash. She is perfectly healthy now and was before that situation. I know that she will be able to get health insurance somewhere due to the new health plan, but has anyone had any experiences being denied insurance or experienced high rate hikes with certain companies? This is CA blue shield. Any insurance stories of any kind (good and bad) would be appreciated, also if anyone has been able to appeal their rate months into a policy due to a clean bill of health. Thank you in advance.

Sidenote: We started this process four weeks ago and are now scrambling. Anyone needing to find insurance, start early!

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answers from Redding on

Dear E.,
Try applying for Healthy Families for your daughter.
I am an insurance agent in CA, (not currently working in that field however) and yes, you can be denied health insurance that is an "individual" policy.
You can talk to the agent or underwriter....sometimes they will give you something in writing that says your daughter must be "sign, symptom, and treatment free" for a certain period of time before you can reapply.
It sucks, I know....but I would really try getting her on Healthy Families. They go by income guidelines and not health history.
Employer sponsored health plans can't deny you coverage for health conditions so I don't know if you have that option through employment. Many people, including myself, can't get health coverage unless it's through my employer because of my health history.
My son had Healthy Families and it was excellent coverage. Most pediatricians accept it. In fact, you may be able to get an application through the pediatrician's office.
You can find more information at www.mrmib.ca.gov

Best wishes!

2 moms found this helpful


answers from Kansas City on

I'm just guessing that the problem is that MRSA tends to come back and spread easily.

1 mom found this helpful


answers from Reno on

My understanding is that if your daughter has had coverage through an employer and no lapse, an employer provided insurance company cannot deny her coverage for pre-existing conditions. Privately obtained insurance companies can deny coverage. (My son has a seizure disorder. Blue Cross denied him coverage for a 12 month wait period, but stated that they would likely not extend coverage, even if we paid for coverage for him and waited out the period. I ended up purchasing the higher insurance through my company.)
There are some christian/religious based insurance companies that seem a little better with providing coverage, although I'm not sure about the costs.
Good luck.

1 mom found this helpful


answers from Los Angeles on

COBRA should be an option. There is also a HIPAA law that says if your daughter has been covered by a group plan for the previous 18 months consecutively, the insurance companies CANNOT deny her coverage. We found this out when they tried to deny our 3 yr old daughter coverage because of a 'pre-existing' condition, type 1 diabetes. (This was before the Health Care Reform Act was put into place.) Good luck. Keep fighting!

1 mom found this helpful


answers from Los Angeles on

My husband has recently been denied because (get this) I'M pregnant.

Yes, that's right ladies. MY pregnancy is concidered a pre-existing condition for my husband's health care.

When they told me over the phone I honestly thought they were joking. They were'nt...... They told me to reapply AFTER the baby is born. :/

This is why we need health care reform. The loopholes these insurance companies have created are down right absurd.

They also told me that the independent child care law starts Dec 28th. No child will be denied for any pre-existing condition.



answers from Los Angeles on

try iehp healthy families plan thats what i have for my 3 1/2 year old daughter



answers from San Diego on

Hello, Maybe I didn't understand the new laws on health care, but I thought it was illegal to deny someone coverage due to health. And, really, is an infected diaper rash a reason to deny anyway? Check with the insurance commisioner's office. You may still be able to get her coverage.
Good luck with your precious family.
K. K.


answers from Dover on

Typically, if you have insurance and it covers your daughter and you are switching she should not be denied. Is this through an employer?


answers from Sacramento on

I have a friend whose kids were in Healthy Families. It actually worked out pretty well for them (I think one of the kids has asthma, therefore was denied insurance by Blue Cross). Kaiser ended up accepting them a few months ago, so maybe try Kaiser too.



answers from Sacramento on

I believe if you get cobra insurance until you get another insurance provider, by law they can not deny you for a pre- existing condition as long as you have not had any laps in coverage. A portion of Obama's health care rolls out in January that states the insurance companies are not allowed to deny children.



answers from Glens Falls on

Work with an agent that can assist you with applying to other carriers.Two other possibilities for you 1) If you have had group coverage in the past and have not had a lapse in coverage of more than 62 days, and took and exhausted any COBRA available to you, than you may be a "HIPAA Qualified Individual" which means that a pre-ex would not be applied to your family under a new policy 2) There is a high risk pool in California. It doesn't have a real good reputation for letting in new enrollees but if you continue to experience rejections, it is an option for your daughter. Contact the Dept of Insurance. Good luck!

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