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bigapplekathleen

Health Insurance Denial

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Hi everyone,

I would like to know what all of you do about health insurance. I am self-employed, and currently finishing out my COBRA benefits from a previous employer. I applied last month for an independent policy through Blue Cross, who ironically, is my current health provider. I just got a rejection letter today, and the reason stated was 'gluten intolerance'. I am appalled. I have virtually NO medical bills related to gluten intolerance. My blood tests for the celiac gene were negative. The plan I applied for was a high-deductible plan under the new Medical Savings Account plan, where I am responsible for paying the first $2500 of bills and then the insurance kicks in after that. The plan costs about $2400 a year in addition to the $2500 deductible, which is significantly less than the $9000 a year in premiums (plus additional co-pays) I am currently paying through COBRA.

What are your experiences, thoughts, and suggestions? I am tempted to just put money in a savings account and pay as I go, but what about catastrophic coverage? I had some really high medical bills before I was diagnosed with gluten intolerance, but in the past year, my medical bills have dropped to nearly zero.

Thoughts?

Kathleen

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What state are you in? In CA we have something called HIPPA which is supposed to force people to insure you if you've been continuously covered. It might be National, but I'm not sure.

I did have to resort to coverage through my state when I was self-employed. It was obscenely expensive though, over $550 a month!

From my own experience, you really need to research and figure this out long before your COBRA runs out because it takes forever.

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Hi everyone,

I would like to know what all of you do about health insurance. I am self-employed, and currently finishing out my COBRA benefits from a previous employer. I applied last month for an independent policy through Blue Cross, who ironically, is my current health provider. I just got a rejection letter today, and the reason stated was 'gluten intolerance'. I am appalled. I have virtually NO medical bills related to gluten intolerance. My blood tests for the celiac gene were negative. The plan I applied for was a high-deductible plan under the new Medical Savings Account plan, where I am responsible for paying the first $2500 of bills and then the insurance kicks in after that. The plan costs about $2400 a year in addition to the $2500 deductible, which is significantly less than the $9000 a year in premiums (plus additional co-pays) I am currently paying through COBRA.

What are your experiences, thoughts, and suggestions? I am tempted to just put money in a savings account and pay as I go, but what about catastrophic coverage? I had some really high medical bills before I was diagnosed with gluten intolerance, but in the past year, my medical bills have dropped to nearly zero.

Thoughts?

Kathleen

I am so sorry to hear about your experience. Unfortunately, it is probably happening to a lot of people. I was denied life insurance because of my Celiac Disease diagnosis. We appealled the decision and the doctor sent a note explaining the wheat intolerance and that did not help. And how did you get diagnosed with gluten intolerance but not Celiac Disease?

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Oh man, that stinks. Sorry you have to deal with this. I don't have any good advise for you, but I think insurance companies are being stupid with celiac disease. Honestly, I am so much healthier now that I have a diagnosis than before. Do they want people like me to go back to weekly doctors visits and several prescription drugs? They are saving so much money now that I'm diagnosed. But I don't think there's any good way to prove this to them.

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Guest Evelyn&Ric

We got Blue Shield PPO insurance from ehealthinusrance.com in 2002. On the form under health conditions, we put IBS (controlled by diet). Ric has not been officially diagnosed Celiac, but has had several tests. In 2006, we increased our deductible because the premiums went up because I’m now 50.

TIP: If you are married, have the spouse who is younger be the primary so that the premiums will be calculated on the younger person.

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What state are you in?

I would like to know that, too. It would be interesting to know which Blue Cross denied you coverage.

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Hi everyone,

Thanks for your replies. I am in the state of Connecticut.

I was diagnosed first with Celiac by some ancient blood tests (IgA or something like that). I consulted one of the top celiac doctors and he said those tests meant nothing. However, I did really well on the gluten-free diet. Nearly all of my health problems went away (and they were extensive...) My biopsy was clear after 18 months gluten-free. (No biopsy was done before I started the diet.) We did the genetic test for celiac (CeliaGene) and it was NEGATIVE. However, my top celiac doc thinks I am gluten intolerant, and unfortunately, that label as well as celiac are all over my medical records. Years of doctor visits, illnesses, and brushes with death left my medical bills pretty high for the insurance companies. In a way, I can't blame them. HOWEVER, now I have virtually no need for medical care. I am never sick and need no medications.

My current COBRA payments are $734 per month. In my humble opinion, even continuing to set aside that much per month should pretty much cover anything I would ever need. My fear is catastophic coverage. What if something big came up?

Any other suggestions out there?

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Kathleen, that is terrible. I haven't been to the doctor yet but do plan to go and get the routine stuff done-physical, blood work, normal stuff --that is if I can figure out who to go to. The health care industry also seems to need some education. LL

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I would encourage you to find some form of health coverage. My father was financially ruined by catastrophic circumstances. He had jus started his own business and his insurance was in a probationary period when he had a massive heart attack. He lost his insurance and his business and had 5 more heart attacks with no insurance. Hopefully not going to happen to you, but you never know what might happen.

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Guest nini

I was also denied health insurance because of Celiac... I challenged that decision and got them to at least say they would insure me but put a waiver on anything Celiac related, that wouldn't be covered for at least a year... after fighting really hard to keep insurance, I still ended up losing it when both hubby and I lost our jobs... I'm on medicaid now but when I have to go off medicaid I'm really nervous about what will happen insurance wise.

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HIPAA is a fedaral law (passed in 1996) which limits insurance companies abilities to deny coverage for pre-existing conditions in most circumstances. You should look into the law, and see if it applies to you. If so, then they can not deny you insurance. You can find more information about HIPAA here http://www.hhs.gov/ocr/hipaa/

The portability part is mostly overseen by the Dept. of Labor, as it usually (but not always) applies to group insurance. There's more info on that here http://www.dol.gov/dol/topic/health-plans/portability.htm

Anyway, see if HIPAA applies. If it does, file a complaint and send a copy to the insurance company. In the meantime, check with some other insurance companies. http://www.connecticuthealthlife.com/healthinsurance.html

Debbie

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I thought HIPPA only applied to group coverage and employers, but that might not be the case:

From http://www.dol.gov/dol/topic/health-plans/portability.htm

What if I am unable to obtain new group health plan coverage?

You may be able to purchase an individual insurance policy. HIPAA guarantees access to individual policies to eligible individuals. Eligible individuals:

Have had coverage for a least 18 months without a significant break in coverage where the most recent period of coverage was under a group health plan

Did not have their group coverage terminated because of fraud or nonpayment of premiums

Are ineligible for COBRA continuation coverage or if offered COBRA continuation coverage (or continuation coverage under a similar state program), have both elected and exhausted their continuation coverage

Sounds like you might qualify!!

I would call the insurance company back and tell them that you qualify under HIPPA for protection from denial of coverage, and pre-existing condition and see what happens. Sometimes the threat of legal protection is enough to make them move, sometimes it takes a filing with the authorities, or a phone call from an attorney that deals with HIPPA alot.

If I were you I would also call the department of labor and discuss this with them to make sure you are in the right! Their number on the weblink above was 1.866.444.3272

Good luck and keep us posted!

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My mother works for an insurance company here. When you have trouble with any insurance company she always tells me to call the Dept of Insurance. The insurance companies really dont like that. But it may help you solve your problem, at least to get some clarity to it.

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My mother works for an insurance company here. When you have trouble with any insurance company she always tells me to call the Dept of Insurance. The insurance companies really dont like that. But it may help you solve your problem, at least to get some clarity to it.

Would that also apply to something like wind/hurricane coverage? LL

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I do work for an health insurance co. I do think that some carriers under certian plans can deny you due to pre-exsisting conditions, (especially if its your going under a non-group plan) but i have never heard gluten intolerance being one. Usually it would be something a lot more serious.

My advice, I would shop around to other health carriers. Im not from CT but I am from NE area, we have one of the highest health insurance premiums in the country, so wherever you go try to find a good deal.

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Forgive me if I'm being redundant :) I cked with my mom who is in HR/insurance. She said the following: Protection under HIPAA is for employees who receive health benefits through their employers and who subsequently change jobs. HIPAA applies to most group plans and I am not aware of any protection for individual coverage. My suggestion would be to contact an agency who deals in health insurance and have them look for coverage. They will have access to many companies and will be able to give a much broader overview of possibilities.

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I too thought it only applied to employees applying for group health coverage, however in my post ( http://www.glutenfreeforum.com/index.php?s...st&p=170832 ) I have a direct quote from the US Department of Labor website that indicates differently. Here is the DOL link again http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html Scroll to the bottom of the page, read the second to last FAQ.

It appears that if a person is unable to get group coverage, HIPAA guarentees access to individual policies for eligible indivuduals.

Eligible individuals must have had insurance for 18 months under a group plan, with no significant break in coverage. Their coverage was not terminated for fraud or non-payment. They are ineligible for Cobra, or have elected and exhausted cobra coverage.

It appears that Kathleen had group coverage from her previous employer, and has elected to use and has exhausted the cobra coverage offered. So unless she committed fraud or didn't pay her previous policy (doubtful since employers typically withold from your paycheck) I would say to call the insurance company and talk about HIPAA with them. If they are still denying you I would talk to an attorney.

Alternatively, in Northeast OH we have a group called COSE. I think it is the Council of Small Enterprises. They are a group of small business that use their combined bargaining power for things like group ealth insurance coverage. If you're running your own company, even if you are your only employee, one can sign up with them and obtain discounted group health coverage....HIPAA would protect you here as well.

BTW: Just trying to help, not trying to argue!!!!

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anytime you have a dispute with any insurance company (medical or wind/hail) getting the insurance department involved is a good idea. I used to work for the KS insurance dept and Insurance companies don't like receiving complaints. They are logged at the dept and then that info becomes public record. Sometimes the sweaky wheel does get the attention!

Monica

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My husband just got a standard rate life policy thru MetLife this year despite telling them he had celiac disease. The underwriters there knew what celiac is and weren't afraid of it.

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