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Old 05-12-2007, 07:19 PM   #1 (permalink)
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Angry Denied health insurance! :(

My husband left his job in March and is now consulting/self-employed. We just applied for health insurance and I have been denied due to PCOS! This is outrageous - I am well managed, a healthy weight and have had successful pregnancies (we're done having kids). I exercise, eat right and am in my early 30's - what more do they want?

Just wondering if anyone else has been through this and if so, what did you end up doing? Does this mean I will be denied forever?
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Old 05-12-2007, 08:18 PM   #2 (permalink)
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That is awful! I'm sorry I don't have any advice for you-- but I'm curious to hear what everyone else says. Out of curiosity, what type of insurance were you applying for?

I'm personally concened about this same issue. I have very crappy insurance right now at a dead end job. My fiance is self-employed but just had a great interview and we think he might get the offer. If he does we will have to move out of state. My mom called me a half hour ago stressed out to say that if he gets the job-- we should get married legally now (before the wedding) before the PCOS becomes a problem with getting insurance. And now hearing your situation--- I'm scared.

Is there anybody out there who knows anything about insurance and PCOS?
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Old 05-12-2007, 09:51 PM   #3 (permalink)
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First let my say Hello, (newbie) Anyways I cant beleive what you are saying..
Seems to me that is a bunch of crap! How can they do that? Its not like you caught PCOS, You are born with it. My husband works for the railroad and has good insurance, I have never had a problem with getting to cover me or my health conditions. (infertility coverage is a nother story) But as far as the medical coverage for the pcos never had a problem.
I wonder how that is legal. Anyways good luck.
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Old 05-12-2007, 10:12 PM   #4 (permalink)
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Health insurance companies in America now will deny you coverage if you have ANY chronic medical conditions. There is no "good" reason for this other than greed and profit.

I had health insurance for many years because my husband's policy covered me. After I divorced and after my COBRA coverage was up, I applied for coverage and was turned down because I had a couple of chronic conditions. I was healthy, never been to the hospital, never to the doc much. I finally have coverage again, because of a job in state government, where I am part of a large group, but if I weren't this lucky, I would never be able to buy private coverage again.

But, private insurers are businesses, and apparently they have a right to deny coverage to anyone who they believe will cost them money, rather than make them money.

Remember that, they are private, for-profit businesses. And start thinking politically about what to do about this. The US is in very very big trouble in this regard.
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Old 05-14-2007, 06:14 PM   #5 (permalink)
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Quote:
Originally Posted by Polly13 View Post
That is awful! I'm sorry I don't have any advice for you-- but I'm curious to hear what everyone else says. Out of curiosity, what type of insurance were you applying for?
Hi Polly, we were applying for Blue Shield PPO private insurance for DH, myself and our 2 kids. I was being listed as the primary on the plan since I am the younger of the two of us. I wonder if that had an affect on their decision? I haven't heard anything further from them about the rest of the family, but I don't plan to do any business with them at all at this point.
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Old 05-15-2007, 12:06 AM   #6 (permalink)
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Some uninsured or underinsured women make too much money to qualify for government assistance but cannot afford to pay for health insurance or costly medical services. This is a difficult situation for women and their families. There are other options for women in this situation. The following are a few options to consider:
• Free clinics. In 1992, The Free Clinic Foundation of America was founded and published a National Directory of Free Clinics. These clinics provide services for the working poor and uninsured. For a list of clinics in your area call (540) 344-8242.
• Prescription drug assistance. Some states provide prescription drug assistance to women who are not covered by Medicaid. Also, many drug companies will work with your doctor or health care provider to supply free medicines to those in need. For prescription drug resources, go to http://www.disabilityresources.org/RX.html.
• Women with cancer. Women who are coping with cancer can find help through a variety of government-sponsored and volunteer organizations. For example, Cancer Care provides free support, information, financial assistance, and practical help to people with cancer and their families. Low-income and underserved women with breast and cervical cancers can obtain assistance from AVONcares Program for Medically Underserved Women. For more information and a list of more resources, contact the National Cancer Institute at http://www.nci.nih.gov/.
• Women with HIV. The federal Ryan White CARE Act funds services for those with HIV/AIDS who are without insurance or financial resources to pay for care. For information about the Ryan White Care Act, call 1-888-275-4772 or go to http://hab.hrsa.gov. Contact your local or state health department to locate a CARE provider in your area.
• Low-Cost Health Insurance Options. Some labor unions, professional clubs, associations, and organizations offer group health insurance to its members. These plans are usually less costly and may be an option to consider.
• State Temporary Insurance. Some who have been denied health insurance because of a medical condition may be able to obtain coverage through State “High Risk Pools.” Over 30 states provide this temporary insurance assistance. For more information, contact http://www.healthinsurance.org/riskpoolinfo.html.
How do you protect your health insurance benefits?
If you are losing your health insurance due to job loss or reduced hours, there are some important steps you should take. Women and their dependent children who lose their health insurance through divorce or death are also entitled to the following protection.
• Obtain proof of previous health insurance coverage from your employer. This guarantees certain protections and rights under the Health Insurance Portability and Accountability Act of 1996, or HIPAA. Basically, HIPAA protects employed individuals and their families who are insured by continuing access to health insurance when leaving or changing jobs. For more information about HIPAA and how it affects you and your family, go to http://www.cms.gov/hipaa/hipaa1/content/more.asp.
• You may be eligible for continuation of your health insurance coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985, or COBRA. Generally, employers with 20 or more employees qualify for COBRA and must allow you the opportunity to continue your health insurance benefits for at least 18 months after leaving your job. You will have to pay more than when you were employed because you must also pay the premium costs previously paid by your employer. But you will receive the same health benefits while you look for another job or until you purchase health insurance. In some cases, you can apply for health insurance continuance after exhausting COBRA coverage through your State-mandated “High-Risk Pool” Insurance.
• Consider your health insurance situation carefully before agreeing to certain terms and conditions. This is especially important in situations of separation or divorce. Also, you may not want to waive certain survivor or retirement benefits as this could impact your health insurance benefits.
• A court order can be obtained to provide coverage for children under a divorced parent’s health plan, even if that parent does not have custody. This court order is called a qualified medical child support order.
• In most cases, there are strict time limitations in which to apply for benefits. So act quickly to get the right information and file the forms required in order to protect you and your family’s health insurance.
For More Information…
For more information about health insurance contact the National Women’s Health Information Center at 800-994-WOMAN (9662) or the following organizations:
Center for Medicare and Medicaid Services, HHS
Phone: (800) 633-4227 (MEDICARE)
Internet Address: http://cms.hhs.gov
Employee Benefits Security Administration
Phone: (866) 444-3272
Internet Address: http://www.dol.gov/ebsa
Health Resources Services Administration Information Center
Phone: (888) 275-4772
Internet Address: http://www.ask.hrsa.gov

State Children's Health Insurance Program, CMS, HHS
Phone: (877) 543-7669 (KIDS NOW)
Internet Address: http://www.cms.hhs.gov/schip
Social Security Administration Office of Public Inquiries
Phone: (800) 772-1213
Internet Address: http://www.ssa.gov
The Center For Women Veterans
Phone: (800) 827-1000
Internet Address: http://www.va.gov/womenvet
TRICARE/Military Health System
Phone: (888) DOD-CARE (363-2273)
Internet Address: http://www.tricare.osd.mil
America’s Health Insurance Plans
Phone: (202) 778-3200
Internet Address: http://www.ahip.org

National Association of Insurance Commissioners (NAIC)
Phone: (816) 842-3600
Internet Address: http://www.naic.org
The Commonwealth Fund
Phone: (212) 606-3800
Internet Address: http://www.cmwf.org

Source:
http://www.4woman.gov/faq/healthins.htm
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Old 05-15-2007, 12:45 AM   #7 (permalink)
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Allison, so glad you posted that...I hope everyone reads that...also, many states provide insurance for people denied that goes beyond temporary. You will need to submit the letter form the company that rejected you (granted you didn't tear it up and stomp on it).
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Old 05-15-2007, 01:53 AM   #8 (permalink)
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Ugh, I really hate health insurance companies these days! I notice though that you are in Sacramento. My sister is an insurance broker and a few weeks ago we were talking about how insurance companies deny individuals. She had mentioned that in California a law was passed regarding small groups. Does your husband have a business license? If so, he can add your name to the business license and the two of you would be considered a small group. At that point they would not be able to deny you insurance as you would be doing it through his business. You may want to consult with a broker about the details, but this is what she told me and she has been in the business for years. Worth checking out. Good luck.
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Old 03-12-2008, 08:35 PM   #9 (permalink)
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MAGAZINE INTERVIEW REQUEST: Had trouble getting health insurance due to PCOS??
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Old 03-13-2008, 05:26 PM   #10 (permalink)
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I had the same issue. I was denied due to PCOS. I know other people who have pcos who got it covered only because thier dr never wrote down PCOS on thier chart. Other wise it's considered a chronic rare diesease and for individuals it is denied. Which is why I'm glad I'm covered under my husbands group insurance. When I got denied there is a program in Califonia for hard to insure called MRMIP. I saw your in Sacramentoi so here's the link. You might want to look into it so you can get covered. http://www.mrmib.ca.gov/
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Old 03-13-2008, 05:31 PM   #11 (permalink)
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I too was denied from Blue Cross for the same reason...I have great insurance through my husbands job though..Thank God! They shouldn't deny you for that..it's just ridiculous
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Old 03-13-2008, 05:48 PM   #12 (permalink)
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I went in for a consult on my PCOS meds and originally the bill was denied by insurance, but then they paid it.
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Old 03-13-2008, 05:52 PM   #13 (permalink)
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Please, please, please, respond to this interview request. Getting the word out about pcos denial is important!!!
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Old 03-13-2008, 07:26 PM   #14 (permalink)
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Quote:
Originally Posted by GlitterStar View Post
Changing subjects a little....I'm new to Sac and am having to find new docs. My new primary is ok, no problems, I haven't met my new gyno yet ( I see her in April) but my new endo sucks and is a butthole. Is there one that you would recommend?
You might want to post this down in Find A Doctor. Also run a search there..
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Old 03-13-2008, 07:43 PM   #15 (permalink)
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I don't know if anyone has tried for health insurance thru Assurant but I had it for a while and was approved with dysplasia on my history. Find a local insurance agent to do it for you because they know how to get it to go thru.

My CEO was taking insurance premiums out of our checks yet not paying them to BCBS. So BCBS stopped our coverage, denied claims and would not talk to anyone but the CEO, who's a big fat liar. One of my co workers was diagnosed with Lupus during this time and it was so sad. She couldn't get coverage from anywhere. We work for a medical billing company so it was sooo frustrating. I signed up for Assurant. Dave Ramsey raves about them. There is a HSA (Health Savings Account) attatched to it. My deductible was $2500 but after that paid 100%. Any money I put in to the HSA was tax deductible and can be used for every medical expense. It wasn't the best insurance but affordable for me ($175 a month).

And if you know you are going to quit a job or it will be a while between insurances than get a crappy little insurance while you still have insurance, even if you don't plan on using it. You get a creditable coverage letter after the end of any policy that usually lasts 2 months. This lets the new insurance company waive the waiting period for any pre-existing conditions.

If you don't have insurance or have a large deductible/copay you can bargain with the billing dept. Insurances write off almost 40% of most charges and bundle a lot of them if the doctor is in network so use that as your standing ground. Also, they want to move money off the books as fast as possible so you can threaten to pay $10 a month or 70% of the total (where an HSA comes in handy). And a lot of hospitals and doctors offices take charity cases and can advise you how to go about getting it.

And insurance companies are profit businesses. You are not a person to them you are a loss of revenue. The doctors are forced to get out of network with an insurance (and get paid squat) or stay in network and collect the fees from you. That's why I am all for National Health Insurance. Here's a link if you don't know about it http://www.healthcare-now.org/resources/hr676.htm

I know this is really wordy but I hope it helps!
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