Somewhat Damaged

I have health insurance now through my employer, and it's pretty good. I've seen mention of women being denied health insurance because of their PCOS diagnosis and was just wondering if anyone had information on why this happens (aside from the obvious of the health insurance companies sucking, etc.), and how to prevent it.

Does this mainly happen to people seeking to purchase their insurance privately, or has this happened to women who have benefits through their employers.

I also saw Kat mention in another thread that it's wise to prevent doctors from using diagnostic codes for PCOS unless absolutely necessary. Does anyone have any more information on this? I'm trying to think ahead....

Thanks.

KatCarney

The economy is so tight right now, that companies are looking for ANY reason to deny people.

Currently, there is no standard diagnosis for PCOS. It's a constellation of symptoms. People are being denied for something that has no solid diagnosis.

So why are doctors using PCOS codes? If you're treating the symptom of hirsutism, then enter the code of hirsutism.

Plus, it's simply more accurate to code the actual symptoms rather than the 'catch all' of pcos (since that means different things in different women.)

It's not a matter of preventing doctors from using pcos codes, as much as it is encouraging them to use codes that are more accurate.

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JosieFB

Group insurance (generally that's what you have through an employer) cannot keep someone joining the group due to a pre-existing condition. They can have a pre-existing condition waiting period, meaning the insurance won't pay for treatment for a time period described in the plan document.

Somewhat Damaged

Thank you Josie and Kat

chickybygawd

I was told by a previous doctor that I had, that if I were in a position where I may be able to get insurance, she could simply change the PCOS code to "metabolic syndrome". Basically the treatment is the same, and insurance companies (in her experience) don't freak out.

KatCarney

that doctor deserves an award!

Of interest:

http://www.soulcysters.net/1889215563-post4.html

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triciaism

Hi,
I have been denied private insurance through Kaiser & Blue Cross due to my PCOS. Blue Cross told me in the denial letter that once my fertility issues were resolved I could reapply (I only put PCOS as a pre-existing not a desire to conceive). I guess they knew that since I did not have children - it might be an issue. They do not want to pay for fertility if they can help it.
Company insurance to my knowledge (here in CA at least) does not/cannot exclude.

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Tricia 36yrs. Dh 43
1990 Dx, 10yrs. w/dh, 7yrs.
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MissTee

I was recently denied insurance with BC/BS and Kaiser Permanente. I am outraged and I don't know what to do at this point. I desperately need coverage. I was bleeding nonstop for months and just recently it stopped. I was having severe abdominal cramps and I felt like I was going to die.

Anyone have any suggestions regarding insurance companies that will accept people with PCOS.

Kalyn

This was a HUGE fear of mine. I am looking for a new job. I got on to DH's insurance because the head of the HR department at his work said if I had a break in my insurance they could deny me as "pre-existing condition" but if I went from one insurance to another with no break they couldn't deny me. So as soon as we got married I switched over so now I don't have to worry about it. I am just going on what BCBS told me.

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MsOpinionated

I'd be personally offend by being denied insurance because they are assuming that you want to conceive and that your condition is preventing that from happening.

I wonder if the same denial exists for a man with ED? Would they deny him because he couldn't help in conception? Probably not. Insurance companies can be so sexist.

Hope you find a company soon. I have my own private insurance that I obtained through my college Alumni Office.

Cynthia

aprilwashere256

Right now I am on state Medicaid. I qualified when I took guardianship of my brother. I've been lucky in getting treatment for PCOS. Medicaid doesn't cover anything fertility related so my doctor has been amazing in finding loop holes to get my treatments.

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adea8

cant believe some of you are experiencing this because of pcos.

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Battling pcos 9 years
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Bertiebugg

If you are denied coverage because of PCOS... you can appeal the decision. Triciaism you have so long to appeal the denial and ask for reconsideration. Explain that you have no desire to have children etc etc... in some cases you can even go infront of the appeal panel and state your case. This could get the insurance for you that you need.

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Weight lose goal for 2008

KatCarney

It's not just the 'fertility' issue, it's your current health state (ie smoker, weight issues, sedentary) as well as, the on-going healthcare costs that they're looking at (meds, doctor visits, future health complications like diabetes and heart problems). (Not that that right, but that's what they're factoring in...)

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