Denied health insurance b/c of PCOS...where do you get yours?

amandas · 12-07-2006, 04:20 PM

Hi, Everyone! I am electively going part-time at my job in January and losing my group health insurance coverage. I applied to Unicare for an individual policy (they are my group provider) and they denied me because I have PCOS. I take Metformin 3X a day, but do not plan to have any more children. I am now working with an agent and he says he can get me Health Alliance (we are in Illinois), but I wonder if I have any other options...where do you get your health insurance? Thanks, Amanda S.

sandra_d · 12-07-2006, 04:42 PM

You might need to find a way to maintain coverage through your group plan with your employer. When attempting to purchase an individual policy, there are often exclusions for pre-existing conditions. I have a friend whose husband was denied coverage because he has high cholesterol. He went without coverage for some time because of this. If you go with a group plan, often they will not deny (and I think they actually cannot deny) coverage for someone with a pre-existing condition.

I would think the agent you are working with would have some options for you.

Sandra

lovesbabies · 12-07-2006, 04:46 PM

Seems there should be an option to continue the coverage you have with the employer at an extra cost to you. Did you ask about that possibility?

julie007 · 12-07-2006, 05:08 PM

Are they outwardly asking you if you have this or is it coming up in your medical investigation? I was never specifically asked if I had PCOS. IMO it isn't a "condition" that is pre-existing anyway....but BCBS did their own Medical background check however they do it and approved us within two weeks.

~Traci~ · 12-07-2006, 05:17 PM

I have never been questioned about PCOS from any provider. There should be a way you can stay w/ your current group coverage but pay an extra cost. Also, can you go under your DH's group coverage? You may have to wait until his new coverage year starts but that should only be a few months (usually they start around the beginning of the new year).

Good Luck!
Traci

julie007 · 12-07-2006, 05:37 PM

I "think" you can go under you DH provided if there is a life style change as you are going to have. Group providers I don't think generally deny for anything.

annem84 · 12-07-2006, 06:04 PM

Hmm, I've never been denied coverage. I am on with my Employer though. I have DakotaCare and my insurance rocks. $500 main deductible and then $18 co-pay till I reach $2000 and then it is free. Hope you are able to find something and soon!

packerfan · 12-08-2006, 01:10 AM

I've been denied by 3 companies, including Blue Cross Blue Shield. I didn't outwardly state I had PCOS (conveniently forgot about it), it was a diagnosis my OB put on an u/s. THe u/s wasn't medically necessary, but because I wasn't sure of an O date (due to having PCOS), he used the u/s to get an EDD. BCBS found it in my records.

When I received the denial, they had included info on a program thru our state. It is coverage for "high risk" people that can't get private insurance or aren't eligible for group coverage. Basically it's "medicaid" for people who don't qualify because of income.

It's actually pretty good coverage (Better than BCBS) and reasonable. No dental though, and my doctors all have to be medicaid providers (they all are).

amandas · 12-08-2006, 10:14 AM

Thank you very much for the replies, everyone. I can continue coverage through my group plan, but it's $400 a month. Through my husband's plan it's $500 a month. I was really hoping to get something cheaper as we are losing half my income.

It didn't specifically ask if I had PCOS, but it asked if I had infertility, irregular periods, or cysts on my ovaries, so I had to report it since I did have infertility treatment and my medical records would have clearly showed PCOs.

The agents I've been working with have 2 possible options for me...both for under $150 a month...but we have to wait and see what underwriting says.

Thanks again for your help, Amanda S

julie007 · 12-09-2006, 09:05 PM

Quote:

Originally Posted by packerfan

I've been denied by 3 companies, including Blue Cross Blue Shield. I didn't outwardly state I had PCOS (conveniently forgot about it), it was a diagnosis my OB put on an u/s. THe u/s wasn't medically necessary, but because I wasn't sure of an O date (due to having PCOS), he used the u/s to get an EDD. BCBS found it in my records.

When I received the denial, they had included info on a program thru our state. It is coverage for "high risk" people that can't get private insurance or aren't eligible for group coverage. Basically it's "medicaid" for people who don't qualify because of income.

It's actually pretty good coverage (Better than BCBS) and reasonable. No dental though, and my doctors all have to be medicaid providers (they all are).

That really sucks...I did the convenient forget also. Somehow they didn't find it. I think it is such crap that they consider PCOS high risk.

molly1971 · 12-10-2006, 01:57 AM

I just got new insurance through work after not having coverage for almost a year-I now have an 18 month pre existing condition clause-blech. So, basically, they can deny coverage for anything I have been treated for in the past for up to the next 18 months, which I am sure they will do. But, having the prescription coverage is nice!