Retarded Blue Shield

[holdthegluten]

I applied for an individual PPO because i got laid off of work and they denied me. I got a letter today stating that I wouldnt be covered by Blue Shield until I was symptom and treatment free for 5 years.........What is the point of the insurance then? How can I prove I am Symptom free, even though I am not. These insurance companies are getting ridiculous with choosing who they cover. Why dont they at least cover me and chrge a premium that is equal to the risk. Unbelievable. It isnt even an illnes that requires daily medication.

[Fiddle-Faddle]

I can't think of enough horrible things to say about the health insurance industry! I'm so sorry you are going through this.

Please keep asking to speak to whoever actually makes the decision--appeal left and right, and hire an attorney if you can (Edgar Snyder comes to mind, as this is a kind of malpractice).

Folks, this is a good reason NOT to get the endoscopy/biopsy/firm diagnosis--if a gluten-free diet works, you have your answer--and the insurance companies have no excuse to deny you coverage. (If the gluten-free diet doesn't work, you are back to square one, but then you have it on record that the gluten-free diet didn't work, so they will hopefully look further for answers for you, and you won't have the celiac label.)

[kbtoyssni]

Gosh I'm sorry. Health insurance scares me for this very reason. I'm so scared I'll lose my job some day and be in this position. Can you get the continuing/COBRA coverage that's usually offered after losing a job? For some reason I thought there was a way to continue coverage without having to apply and deal with all the pre-existing condition stuff. But I might be making that up.

[labbott]

  holdthegluten said:

I applied for an individual PPO because i got laid off of work and they denied me. I got a letter today stating that I wouldnt be covered by Blue Shield until I was symptom and treatment free for 5 years.........What is the point of the insurance then? How can I prove I am Symptom free, even though I am not. These insurance companies are getting ridiculous with choosing who they cover. Why dont they at least cover me and chrge a premium that is equal to the risk. Unbelievable. It isnt even an illnes that requires daily medication.

I had major health issues and was finally dxd with celiacs. After I was laid off I had to find my own insurance and was also denied coverage because of my history. (of course if the stupid Drs had listened to me we could have avoided my whole history but whatever) Anyhoo, it is standard to deny coverage with anyone who looks like they are high risk. But if you have had continuous coverage they have to offer you a high risk policy. They don't volunteer that info though. You have to ask for it. Even though they are required by law to offer it they won't tell you about it unless you ask. Contact your state's insurance regluation group and they can tell you what you need to know so you can talk inteligently with the insurance company. Then when they tell you to fill out apps and they will review you have to follow up with them. Every day. There is a time limit of I think 45 days. So if you go more than 45 days without coverage then they don't have to offer you a policy. The insurance industry is criminal.

[Jenny (AZ via TX)]

  kbtoyssni said:

Gosh I'm sorry. Health insurance scares me for this very reason. I'm so scared I'll lose my job some day and be in this position. Can you get the continuing/COBRA coverage that's usually offered after losing a job? For some reason I thought there was a way to continue coverage without having to apply and deal with all the pre-existing condition stuff. But I might be making that up.

I had also heard that as long as you didn't let the coverage lapse in between coverages, you were fine. When I had switched coverage (before celiac) from my work to my husband's, I had several tests at an ENT. I had to send proof that my coverage had never lapsed. After that I had no problems.

[ShayFL]

All insurances suck from what I can tell...I have had Aetna and Blue Cross/Blue Shield (current). Sometimes they pay for things and other times they dont. FOR THE SAME THING!!!! Like lab work.....

[Phyllis28]

You may qualify for insurance through a high risk pool available through your state. I know California has one and I believe many other state also have them.

Also check the availablity of insurance through your former employer using COBRA if you have not already done so.

[blueeyedmanda]

I too hate the insurance industry. Thankfully I do have full coverage through my job but its crazy. Our ER copay is 75 bucks..crazy!

[Nancym]

Yes, isn't US health care wonderful?

You should be eligible for COBRA for 1.5-3 years, why not sign up for that?

[Silly Yak Pete]

That is why we need socialized medicine in this country..

[Lockheed]

yeah saying I'm a celiac did horrible things to my life insurance premium.

[darlindeb25]

  Quote

That is why we need socialized medicine in this country

This most definitely is not the answer for the US. Socialized medicine is much worse. You can't get into a doctor for months at a time, they tell you where you can go, just the same...good doctors do not want socialized medicine, they would never beable to get tests done for you.

I have heard many Canadians complain about it. Hospitals are not equipped to care for very sick patients, etc.

Open Original Shared Link

What we need is some kind of a cap put on the insurance compaines, and we need doctors to not run needless tests, which also brings up the cost of health care.

[Tim-n-VA]

Since members of this forum probably read more medical stuff than any group not employed by the health care industry, I have a slightly off topic question. Has anyone seen any studies that evaluate medical innovation by medical system - i.e. government funded versus for profite, etc? The potential concern would be that with profits capped, companies would not think it worth the risk to to conduct research.

The extra tests, etc. that drive health care costs are partially influenced in the US by our general tendency to sue for any less than optimum outcome. I suspect that has a lot to do with doctors not wanting to diagnose celiac without a positive blood and a positive biopsy.

[rpf1007]

What we need is some kind of a cap put on the insurance compaines, and we need doctors to not run needless tests, which also brings up the cost of health care.

[Fiddle-Faddle]

What about the fact that most health insurance companies USED to pay for just about every drug under the sun--then, when most people in this country actually believed that they NEEDED all those drugs, the HIC's said that they would only pay if said drug was on their formulary--and then the copays went up and up and up...

Synthroid used to be $4 for 30 pills. Now it's 5 times that much. Does it cost them 5 times to produce it? NO!

And what about all the elderly patients who are on 27 different medicines--how many of those medicines are necessary? Or how many of them are to mask side effects of other meds?

Insurance pays for vaccines--but not for titres to see if the patient is already immune, including the MMR, which gives lifetime immunity with one dose--but two doses are "required." And they don't pay a penny if you or your child has a terrible reaction to the vaccine.

They pay for antacids, H-2 blockers, thryoid meds, anxiety meds, insulin, anti-inflammatories, sleep meds, and all kinds of cortisone treatments (skin and pill form) to combat what we here all recognize as symptoms of gltuen toxicity, but then when you actually find out that you can't eat gluten (and can save them a bundle on prescriptions you no longer need), they deny you coverage.

[debmidge]

  Phyllis28 said:

You may qualify for insurance through a high risk pool available through your state. I know California has one and I believe many other state also have them.

Also check the availablity of insurance through your former employer using COBRA if you have not already done so.

Call your past employer immediately about COBRA availability

[debmidge]

Open Original Shared Link

Info site about each state's health insurance rules and regs.

My E.R. Co pay is $100 per visit -

I am in the insurance business - keep in mind that the lower the co pays and deductibles the higher the annual premium.

[debmidge]

  Fiddle-Faddle said:

I can't think of enough horrible things to say about the health insurance industry! I'm so sorry you are going through this.

Please keep asking to speak to whoever actually makes the decision--appeal left and right, and hire an attorney if you can (Edgar Snyder comes to mind, as this is a kind of malpractice).

Folks, this is a good reason NOT to get the endoscopy/biopsy/firm diagnosis--if a gluten-free diet works, you have your answer--and the insurance companies have no excuse to deny you coverage. (If the gluten-free diet doesn't work, you are back to square one, but then you have it on record that the gluten-free diet didn't work, so they will hopefully look further for answers for you, and you won't have the celiac label.)

Well......I am in insurance -- at the risk being unpopular I have to say that there's a lot of acturarial reasons

why an insurance company declines a "risk." Sometimes they'd like to write it at the higher premium but the State Dept. of Insurance is prohibiting them as the rate would be excessive and against public policy. All rates and rules are always approved by your State Dept of Insurance - so it's not necessarily the insurance company giving you the hard time.

Insurance is probably one of the only industries to allow "fair discrimination." This being said, an attorney will not take on a case such as this unless you are being denied coverage for your sex, marital status or religion. Health Insurance companies can deny based on health condition, maybe age too if you are eligible for Medicare - that's a grey area, and type of occupation/hazardous activities like skydiving

If an insurance company can prove actuarially to the State Dept of Insurance that they cannot make a profit in a "line" of insurance, they get permission from the state to decline or limit the coverage or just not write it at all.

You are absolutely correct about not pushing for a firm diagnosis - nothing on paper or in writing...however you can get snagged when you answer the question: Have you seen a doctor in the last 5 years? If you are still messing around with doctors because you have not been feeling well and you are going from Dr. to Dr. for an answer, the response to that question is probably going to be "yes."

My best advices are these:

1a) Always, always take COBRA if offered to you. If your employer is too small for COBRA law then you have a problem....always find out before you take a new job if the employer is subject to COBRA law or not.

1b) Try to get coverage off of your spouse's policy at work, if your spouse works. If your spouse works part-time and only full-timers get health insurance, then perhaps your spouse should increase his/her hours in order to secure health insurance for your family. However, a Pre-existing condition may apply there too.

1c) Never let a lapse happen (see your state guide at site: http://www.healthinsuranceinfo.net)

1d) Group policies have more flexible rules than personal policies do. So always stay with the group or get COBRA from the group.

2) Never apply directly to the insurance company, if you can help it. Go through an expert agent who can

assist you in answering the tricky questions and/or the agent can assist when they know what

health insurance companies are more "with it" than other companies when it comes to celiac.

3a) And the ever unpopular: Keep in mind that insurance companies are not charitable organizations and are only in business for profit, like any other business. Unfortunately, there is a "blur" because the "Blues" used to be non-profit in many states. If insurance companies don't understand a "risk", like celiac, they'll put up

obstacles to coverage or decline outright. If you are not symptomatic, then take their coverage

with the waiting period if you feel that nothing "celiac" will happen in those 5 years. You can't come down with celiac again if you are on a gluten-free diet, etc. So what then exactly is "Blue" excluding in coverage? Any other new health condition shouldn't be attributed to celiac....that would be unlikely....I don't feel that any doctor would

connect a dot between A and B and write that down as an official diagnosis, especially when many doctors

don't know celiac when it's staring them in the face. Let's take advantage of their ignorance.

3b) Also unpopular is the fact that health insurance is not required by law, so therefore, insurance companies do not have a legal obligation to provide it to everyone - like assigned risk auto or workers' compensation, no matter what your health condition is.

I have had the unfortunate experience to know people who neglected to take COBRA and developed cancer while uninsured. These people have no insurance and no way to get it. They have had to sell their home to pay for the cancer treatments (and move in with their son). The sad fact is that they had the opportunity to take COBRA, and had the money for COBRA premiums, but still refused it. I can't stress enough to people that the consequences for not taking health coverage are high. It is the most expensive financial gamble you'll make. I'd like to say the situation can be fixed, but just like many things in life, it can't be fixed once you make a bad decision. A lot of times in life we "pay" for bad decisions. When you don't take COBRA, it's not the insurance industry's fault. COBRA was put into effect to alleviate the "pre existing" condition consequences.

4) Apply to several health insurance companies at once and "shop" it.

5) On applications, do not volunteer information or lengthy explanations

6) If you have insurance issues and would like to complain:

1) Make a written appeal to the insurance company - if they don't satisfy you then,

2) Make a written complaint to your State Dept. of Insurance

7) Please read the info found in: Open Original Shared Link before doing anything rash (#6 above)

8) Some states have more insurance consumer protection laws than others - again, the state has a lot to do with it too.

9) Contact your state legislators (not federal because the federal govt. does not regulate insurance....yet). Tell your state legislators about how you feel that you get denied coverage.

[darlindeb25]

I work for a doctor, I am on the inside looking out. It's the health industry in general, not the doctors causing the problem. It's like others have said, doctors order tests to cover themselves, just to protect themselves. Like with Medicare, the doctor is told what he must charge, it's not up to the doctor, Medicare sets the amount. With HMO's, the doctor, hospitals, etc, must accept whatever the insurance pays them.

I was prescribed physical therapy, I just received the EOB for the first visit from my insurance. The theripist charged them $290, he received $60, including my copay.

I work for an optometrist, we have one insurance company that pays him $15 for the visit, most of those patients do not have copays, and this insurance is taking over. There is a lot of overhead in a doctor's office, plus staff...with 2 paitents an hour, that's $30....this is what is raising the cost of health prices. It's not the doctors causing the problems.

  Quote

They pay for antacids, H-2 blockers, thryoid meds, anxiety meds, insulin, anti-inflammatories, sleep meds, and all kinds of cortisone treatments (skin and pill form) to combat what we here all recognize as symptoms of gltuen toxicity, but then when you actually find out that you can't eat gluten (and can save them a bundle on prescriptions you no longer need), they deny you coverage.

This is so true, but the pharmacutical industry doesn't want celiac's to be diagnosed, they want us to think we need all these meds! That's why there isn't more research in celiac/gluten intolerance...it doesn't pad the pockets of the pharmacutical industry. Most research is backed by this industry. Celiac disease does not make them wealthy.

It's a never ending battle!!!