Health Insurance

[calico jo]

I wasn't sure where else to post this, under "doctor" seemed most appropriate.

I have been shopping for health insurance recently, since my $600 quarterly premium just went up to $900. An agent I met with today, after meeting for an hour and reviewin my options, then asked..."what is it you have?" I told her and I'm on the "denial" list for coverage. WHAT??? I never got an official dx, just had blood work showing elevated levels of the things that are elevated when you have celiac. After giving up gluten, first, then having to eat it for a week for the blood test and becoming violently ill, it was quite apparent to me already. I never followed up with endoscopy for same reason...didn't want to be non functional for 2 weeks while I gluten loaded.

Has anyone else encountered denial of health insurance. Doesn't this sound ridiculous?? I wonder why it's on a no-no list.

[Guest ~wAvE WeT sAnD~]

Calico Jo-

OH, yes I have--or better yet, will do so tomorrow, because I have an appointment with a nutritionalist. I am paying $50 out of my own pocket because Blue Cross/Blue Shield apparently doesn't cover it.

[Guest ~wAvE WeT sAnD~]

Question...you do have to ingest gluten for an endoscopy? I'll be violently ill, too then. I'll vomit myself right off the table.

[debmidge]

Calico:

RE: Health Insurance

It appears that they are not denying you coverage, but seriously increasing the price. In order to find out if this is legal, you must call the Dept. of Insurance in your home state. I am in insurance for a living so in one way it makes sense to me, but as the wife of a celiac, it doesn't. Why it doesn't make sense: As far as my reading about celiac, the government doesn't recognize celiac sprue or celiac disease as a disease which you can collect permanent disability for. This would be my argument. That if having celiac disease increases the "health insurance risk" why then doesn't the govt allowed people with celiac disease to collect SSI?

Another idea is to shop around. What one insurance company feels is a risk, another might not. All insurance companies are not created equal. Sometimes they make up stupid underwriting rules because the person doing it is ignorant. For example: one of my insurance companies denied to write a fire/liability policy for a business building owner because one of his tenants was a pizzeria and they delivered pizzas. The underwriter advised that they were not allowed to insure businesses that deliver anything. When I asked for an explanation, the underwriter replied that if the driver of the pizza delivery car had an accident, the owner of the building could be sued. I nearly laughed off my chair! The owner of the building would not be sued because he doesn't own the pizza business nor owns the auto being used by the delivery person! (That's like saying that if you live in an apartment, your landlord could be sued if you have an auto accident on your way to work) I pointed this out to the underwriter and she retracted the statement in a confused voice. When she thought it over, she agreed that her company should provide insurance on the building and the pizzeria as a tenant was OK.

Sometimes you have to provide undebatable proof that you are no greater a risk to that insurer than the average person, so therefore you should be charged the average rate. I will have to say that health insurance premiums for everyone have risen exponentally, so maybe you were due to get this price increase anyway. Many states have published rates at the Dept. of Insurance which are guidelines that the insurance companies use and maybe your state does this. If so, they might tell you to go to a particular website where it's published.

If this fails, shop around.

[calico jo]

thanks for the insighted response. Actually celiac sprue is on the do not write list for three of this brokers companies. I already have insurance, about to renew or expire, in which the premium went up 300 a quarter. Since I had no official dx I'm hoping I can get around that, though blood work in my medical files will show I was tested for celiac.

I have just begun shopping around and was worried that I'd run into this more and more and found it very odd. As long as I stay away from gluten I'm healthy. I'm probably healthier than a lot of folks they insure. I walk 4-10 miles a day EVERY day (have a pet care service..walk dogs all the time), don't smoke, etc. etc.

The rates and plan this agent/broker had were very good and about all I can afford. Hoping I can get around this. I was just curious if anyone else had problems and wonder why the insurance companies seem to think this is a high risk.

I also was a property/casualty insurance agent for 13 years and saw a lot of odd underwriting decisions. I'd have been more concerned over the fire risk of a pizzaria tenant than delivery. I'm sure we could share some stories!!!

Jill, yes, it's my understanding that you have to gluten load to get an accurate reading of the endoscopy. They want to confirm the damage that is being caused to your insides by the ingestion of gluten. I also think BCBS and many insurance companies just plain old don't cover appts with nutritionists...they're not "doctors" Pretty much anything holistic won't be covered on insurance. Doctors, insurance and prescriptions all seem to be tied together and making tons of money. Natural remedies don't make profits for them.

OK...that's a whole 'nuther subject for another time.

Take care, all.

[crc0622]

I am sure it has a lot to do with our increased chances for other autoimmune disorders which would increase their costs, and the increase chance of lymphoma. More doctor appts, any way you look at it. They aren't going to insure any demographic if they don't think they'll make money from it.

[kvogt]

If asked whether I have celiac sprue, or not, I would say NO. After 18 months on the gluten-free diet, my gut is healed and I no longer have the disease.

[calico jo]

But they look at medical records and mine has a blood test which shows elevated anti gliadin (is that right?)

[lovegrov]

If you weren't ever diagnosed officially you can fudge about it (technically, we always have celiac or at least the condition that causes celiac; there's no cure) but if you have official results, the insurance company will see those in a medical databank. They will catch the lie.

I don't know about health insurance but I know somebody who went for extra life insurance. A couple of companies wouldn't take him and the company that did required him to get the blood panel to prove he wasn't eating gluten. He got the insurance for the same price as anybody else.

richard

[calico jo]

Thanks Richard...that's interesting to know. Gosh, I can't imagine anyone EATING gluten with this! If I so much as accidently ingest a crumb I'm sick for days.

[lovegrov]

Actually there are a lot of people with celiac disease who don't react at all contamination or mistakes. I'm one. A few months ago I mistakenly bought the wrong flavor of a beef jerky and ate most of the large package before I realzied I had bought the one with wheat starch in it. A really stupid mistake but I had no obvious negative reaction of any kind. I suspect I could eat a sandwich or pizza with no reaction, although I don't intend to find out if I'm right.

richard

[jenbody2003]

I wouldn't go so far as to lie to my insurance...but if you are relatively healthy and don't get sick very often, you may want to consider a MSA or Medical Savings Account. Before you do, read up on it on

www.clarkhoward.com

and see if it is right for you. If you are a member of a Credit Union, they may offer MSA's as one of the perks. (or something similar)

Clark Howard is a great financial advisor who is a little nerdie but not as boring as most financial smarties. Hope this helps!

Also, some physicians give discounts for having one because you pay cash upfront. Discuss it with your doctors offices if you seriously consider this option.

[celiac3270]

I don't think my parents have had any issues with my celiac and the insurance companies....

Jill, yes, you need to load on gluten for at least a month before a diagnostic endoscopy...maybe longer depending on how long you've been gluten-free....you need time to tear up your intestines.

[Melanie]

My understanding is if you don't have an official dx even if you have abnormal blood work, your insurance co won't take the blood work as a dx or problem. Your doctor has to write that you are Celiac.

My doctor explained it that way to me. I have some abnormal blood work (not celiac related) and some symptoms of a disorder, but no doctor will give me a diagnosis because I don't meet all the criteria especially the #1 criteria. I'm even on medication for my symptoms and have applied for new health insurance and they did not mention any of this even though I told them about my doctors and medication. I don't have a dx so they can't hold against me. So I don't think your elevated test levels are what caused your premium to increase. They should be able to tell you why though.

[MySuicidalTurtle]

"but if you have official results, the insurance company will see those in a medical databank. They will catch the lie."

Why would your insurance company look at your blood work and all that jazz to see that you have Celiac Disease? Do they go over every test you have to see why you are being seen and what is wrong with you? I am very confused. My family (3 out of 4 have celiac disease) have never had issues with insurance or anything.

In a little bit when I leave will it be hard for me to find coverage?

[celiac3270]

Yes, my family has a plan all together, as well--maybe that's why I, too, haven't been having issues.

[tarnalberry]

Another thing to consider is that if the family coverage comes through insurance provided by a employer of a large number of people, they may not be allowed to deny coverage for pre-existing conditions. I don't remember the exact rules that determine the numbers, or if it's true in all states, but it's one of the reasons why workplace insurace can be a really big deal.

(for MySuicidalTurtle - I don't know the extent to which they review your medical record, but they do check. Insurance companies check those records to make sure that you're not likely to cost them far more than you'll pay them in premiums. The difficulty you have getting insurance will depend on how you get insurance and what kind of insurance you get.)

[MySuicidalTurtle]

Sigh, it's all so crazy.

[calico jo]

Well, I was declined due to "medical history" No details are being provided to me, unless I send a request in writing for the insurance companies to mail their reasons to my doctor. I can THEN get the reasons from my doctor. (after paying for a doctor visit, I'm sure!) I never had an official diagnosis, and who knows if it's even THAT that they're looking at. I'd had an MRI on my head prior to dx because it was thought I might have MS (had such severe neuro problems) Maybe that's why I was declined. I need to get back on this and find out the reasons in case something is amiss.

I had become a member of one of those health organizations and decided to drop that as well. Just because I have one of those memberships doesn't guarantee to the doctor that I am capable of paying a (discounted) bill up front. Why not just set something like that up in advance directly with the doc without paying the $60-90 a month for a (bogus) membership.

My main concern is catastrophic illness or accident. I'm still searching.....such a frustration.

I'm probably healthier than a lot of "insurable" candidates. I don't eat any processed foods, walk 4-10 miles a day. With this illness, it forces me to take really good care of myself.

[taneil]

I was diagnosed through entrolab and it didn't say celiac disease but gluten intolerance. I applied for a high deductable health insurance with an HSA acount and the question the underwriter asked was "Were you diagnosed with Celiac Sprue or only Gluten intolerance". I had to with draw my application because of some other circumstances, but by the was the question was asked I don't think they would have denied me for gluten intolerance, but they might have if I put down celiac disease. I won't find out for sure though.

[lovegrov]

Calico jo, you should be able to get the reasons from your doctor without an appointment. If not, you need a new doctor.

richard

[ideagirl]

I've never had that much scrutiny when applying for health insurance. I mean, I never had an insurance company actually ask to look at tests. They generally just ask what my medical history is (diagnoses, operations, hospitalizations, etc.) and my lifestyle (smoking, exercise), and in most cases they would still cover you but either at a higher price (this isn't legal in all states), or with an exception like they would cover you for everything EXCEPT "pre-existing conditions."

Check with Blue Cross Blue Shield, or whatever they're called in your area (e.g., Highmark, Blue Cross, etc.). And call your state's department of insurance to see if they can point you towards insurers that won't screw you over. Also, if you have a good job (one that offers insurance), there are generally no tests at all--they just cover you as part of the job.