Insurance Denied for PCOS

Rebecca S · 11-15-2006, 04:28 PM

Hi,
I was diagnoisised with PCOS when I ws 23 in 1988. Since then I have had many insurance carriers, (Pacificare, Healthnet, Kaiser Permente) etc.

For the first 5 years I was on birth control pills, but after a few years of marriage decided to stop taking them. I currently do not take anything. So basically, I get my annual exam and pay the insurance premiums.

This year we decided to change the insurance from Kaiser Permente to Mid-West National Life Insurance Company of Tennessee. Yesterday I received a letter of denial due to my PCOS. I am stunned at this, since in 18 years have never been turned down.

That's all I have, I haven't had an operation or shot since 1977, or the flu since 1992. My cholesterol and blood pressure are fine etc. They asked no questions of family history, (my Grandma is a size 16, smokes and is 88 and going strong) they are just assuming that one day I MIGHT get diabetes or heart diease. As you know not all of us have all the same symptoms and we are not all doomed to get any of the great side effects of PCOS.

SO, for all of you small business owners, if a insurance agent is offering the benefits of being a meneber of "Alliance for Affordable Services" and through that group offering Mid-West health insurance save your time of the 2 hour sales pitch. You will just be denied, have to call tons of numbers to cancel your husbands policy and wait for your refund of $551.

tk26225 · 11-15-2006, 04:37 PM

Rebecca,

I'm sorry to hear about your insurance being denied! I think that is terrible that insurance companies are able to do that. I'm not sure what you can do, if you might be able to fight it and be reinstated? I think it's good that you are exposing them, I think turning down women for healthcare when they need it the most is just wrong! I hope you can find a BETTER insurance company that doesn't put you through this soon!

Best wishes,

AudaciousFurball · 11-15-2006, 08:34 PM

I'm sorry to hear about your insurance problems. See, this is where I think the U.S. gets it seriously wrong. Why don't you guys have a National Health Service? O.K. I have to admit, the Spanish service ain't the best in the world and it's crap at best, but at least my doctors and specialists are free, and coz I get subsidized meds for a "chronic" condition, my met and thyroid meds cost about 30 cents each pack. I think it's amazing how much americans have to pay and fight just to get decent treatment, which, to my mind should be a right, not a luxury purchase.
Fight the company, get it out in the open, do some damage. They might learn from that, *wish*

Best wishes,
Dannie.

Snoodler · 11-16-2006, 12:03 AM

I can't believe that American Health Insurance is like that. I'm sorry you are having problems. Unfortunately I have read several stories about this very thing on other internet sites. I can't comprehend how something like PCOS can be viewed as this "disease" that's going to cost sooooo much money to treat. Obviously someone who has never heard of it made up those rules. Here in Alberta, everything is covered (so far) by our insurance, but only up to 6 months of fertility meds will be covered. Which includes Clomid and anything else, so if TTC takes a long time, it could be costly. One of our insurance companies has part of slogan: "paying for prescription drugs shouldn't be a hard pill to swallow."

I hope you can get someone (lawyer or something) to help you get your $$ back, and find a new insurance company to cover your family.

to you, try not to let it get you down.

JosieFB · 11-16-2006, 09:26 PM

It's wise never to cancel one insurance policy until you have the replacement in your hand. This goes for life, health and automobile.

It sounds like you are self employed. There are some insurance companies who do not deny coverage for a pre-existing condition of PCOS, so keep looking. Also, look around for group insurance through the chamber of commerce or some professional society related to your work. Group insurance cannot deny coverage.

No amount of complaining will get the insurance company to change it's mind. For private individual insurance companies to make money they have to insure people are are believed to be healthy. If everybody they insured had more claims than the premiums they paid, the company would go broke.

The U.S. healthcare system has its pros and cons. I would not want to give up my freedom of choice. I can choose any doctor I want. I also would not like to wait in line to be treated. I pay extra for a insurance policy so I can have those choices. I've heard horror stories of socialized medicine in other countries where there is no choice and the lines are long to be treated. If we go to National Healthcare, as our population ages, the burden of healthcare will fall on the youth of the country as they pay higher and higher taxes. I'm not sure that's fair either!

SnowFlower · 11-16-2006, 11:29 PM

I am sorry about your insurance