Insurance - PCOS is automatic denial!!!

kricket · 08-18-2005, 05:32 PM

OHHHH, I am sooo mad! I am considering changing jobs and the place I want to work has no insurance. I called Blue Cross/Blue Shield and asked them about pricing for personal insurance and they started asking questions. Of course, they asked about any medications I currently take - Metformin. I explained that I wasn't diabetic, that I was taking it for an off-label use and she asked what that was. I said PCOS - that's when she told me that PCOS is an automatic ineligible. ?????

I'm so mad. I need to get out of the place I am - I'm just miserable doing this job!

Thanks for letting me vent!

Shelly

karlij · 08-18-2005, 05:40 PM

Hi Shelly, I've had Blue Cross Blue Shield insurance through my job, then switched to a differnt branch of BCBS through my husband's job, and I've never had any issues with them covering my PCOS-related treatment. Maybe you could call back and speak to a supervisor? Or contact them in writing? Good luck :-)

DAnth76 · 08-18-2005, 05:41 PM

Did she even say why it was ineligible?

Phoenix Rising ^^^ · 08-18-2005, 05:42 PM

I'm shocked! I can't believe that! Did they say why?

BayGirl · 08-18-2005, 05:48 PM

WOw.. i had BCBS (Empire BCBS since i am a NYer) when I was diagnosed with PCOS... NEVER an issue coverign ANYTHING at all. Wow... I'd call back and ask to speak to a manager!

Tiggamoo · 08-18-2005, 05:48 PM

I'd like to know the reason too. I've had blue cross blue shield with two different jobs over the past three years. I was diagnosed while with one job/insurance and I didn't have a problem with coverage with the next job.

Molanna · 08-18-2005, 05:54 PM

The insurance companies have different rules & regulations if you are trying to buy an individual policy rather than getting coverage through a group/work. It is also a heck of a lot more expensive.

There are federal statutes that control what insurance companies can and cannot use to deny coverage--I read up on it a little because DH is considering a job change. See this link for the actual laws.

Best of luck to you, Shelly,
Molanna

VivC · 08-18-2005, 06:01 PM

PCOS, if untreated, can lead to heart problems and diabetes...Infertility treatments cost money, and in some states they're covered...The risk of PTL and M/C can raise insurance costs, too. Insurance companies don't want to deal with those costs, so they refuse to insure us. Which sucks, but they're allowed to get away with it. Same goes for life insurance, gals - I can only get group insurance!

I had two thoughts - find a job that DOES offer group insurance, or look into a conversion policy with your current insurance company. In MD, they have to give us a conversion policy, regardless of medical conditions, as long as we haven't been uninsured for more than 59 days.

BlueAngel22 · 08-18-2005, 06:11 PM

I too was denied by BCBS because of my PCOS when I was taken off my mom's insurance on my 22nd birthday. I haven't tried any others yet, mainly because I'm too afraid of being denied by them also! Unfortunately, I'm not going to be having a job any time soon with any benefits, and the insurance universities offer are supplementary. I'm not sure when I'll be able to visit my ob/gyn who diagnosed me again. I'm a 22-year-old college student... I can't afford those costs without insurance!

MsGreenEyes · 08-18-2005, 07:39 PM

BCBS & PCOS....

FIGHT with THEM!!!! I've had BCBS for almost 6yrs. Every time I go to see my endo for PCOS, BCBS send the statement back saying it's denied. I have to call EVERY time and go through the whole explanation again that mine is for the TREATMENT OF PCOS SYMPTOMS, and NOT FOR INFERTILITY. The first time right after my diagnosis I had to send the statement back with a note from the doctor stating that he was not treating me for infertility. Since then it's still taken a phone call every time, but no more notes. It's a pain in the butt, but at least they do finally pay their part.

Of course, this is through my work, and not an individual policy...but, I'd still suggest calling BCBS back and speaking with a supervisor. Ask what you would have to do to get it covered. Do they need a note from the treating physician as to the specifics of what he's treating you for? Do they need a letter of medical necessity from the physician? If so, that can be done.

Don't take NO for an answer! FIGHT!

SnowFlower · 08-18-2005, 07:49 PM

thats awful =(

StarsHallowGirl · 08-18-2005, 07:51 PM

I know exactley what you are going through. With my group insurance Blue cross has been great but, I was between health insurance jobs and tried individual. I too got denied because of my PCOS. In CA there is a hard to insure insurance. Your not covered for the first 3 monthes but after that you have full coverage. It was expensive though for me it was 226.00 a month at age 22. You might want to check if that's available in your state if you can afford it. I know trying to deal with he insurance companies is like trying to break a brick wall.

Take Care and I hope everything ends up good for you.

choirmissy · 08-18-2005, 09:42 PM

I have BCBS and my PCOS is covered with the exception of infertility issues. I would fight that. I would also call and talk to more than 1 person, and get names of the people you are talking to. Keep asking for the person's supervisor until you can get an adequate explanation. Insurance companies are pros at "not knowing" what is going on. If you don't fight it, they don't pay.

OrangeDaisy · 08-19-2005, 12:54 AM

All of you who are telling Kricket to fight it don't understand. An insurance company can deny anybody they want to on an individual insurance policy. It doesn't make economic sense for them to insure a person where it will cost the company more than the premiums they receive. Fighting it isn't an option.

I'd check with other insurance companies, look into major medical only (pays only in the case of surgery or hospital stay for injury, etc) and sock money into a savings account to pay for doctor's visits. Go to one of the quote websites, and you'll find the names of lots of companies. Or find an independent insurance agents who sells many different brands of insurance.

Consider joining some kind of professional association related to your job if you change employers. Professional associations (for example Tennessee Society of CPAs) offer group insurance. I read on this board just a few days ago that someone who owned their own business joined the chamber of commerce and got their group insurance through the chamber.

It will take time and effort to find something. Good luck!

cec414 · 08-19-2005, 05:06 AM

In Florida, which is terrible when it comes to insurance, so TN can't be much worse, I know people who have been able to sign on with BCBS with an individual policy, but with the agreement that any pre-existing medical conditions will not be covered. They had to speak to a supervisor. Also, you could incorporate yourself and your spouse, and you may be able to get group coverage(not sure how it works) but I know people who do that to be able to get the full coverage from BCBS, but then you'd be paying the premiums since you'd be the "employer" and you'd have to pay to incorporate yourself and you'd need another person on board.

You really need to look into what TN covers, usually states with high taxes have better medical benefits for people, but like here in FL where there is no state income tax, we are pretty much left to fend for ourselves if we don't have coverage through work.

Also, you are entitled to COBRA for 18 months after changing jobs, it is federally mandated no matter where you work or what you do after you leave your job, but you will be paying through the nose, but you get the EXACT same coverage as you did when you were working. You cannot be denied COBRA because of PCOS.

I am in the same boat as you since I had a pituitary tumor removed, I am black listed now for insurance, my doctor never put PCOS in my file, but the tumor is now an automatic rejection unless I come on board with it not being covered, so I am lucky in that I will be attending grad school for three years and will have some kind of coverage, but when I graduate I am thinking of moving to a state where they force insurers to cover people no matter what.

Good luck and look into your state's insurance policies, since we can only suggest things on here, it's really about what goes on in TN and with regards to "fighting" you might be able to convince someone to take you on without covering PCOS, but Orange is right that if you have crappy laws in TN, the insurance companies can be as exclusive as they want to be! When you are already covered through work, or covered by an individual policy, and you get sick, it is much easier to "fight" to get a service covered, but when you are applying to be covered, depending on the state laws, the insurance companies like to take on as little risk as possible, and chronic conditions are pretty risky for them, and it's not fair to the people who get them but that's the way it works in many states. Let us all know what you decide to do and maybe you can keep looking around for a job that will cover you or you can maybe negotiate with your would be new employer and ask if there is any chance of being covered by insurance or if you are promoted, you would be offered benefits. At my last job, I started out w/o benefits, and within a week, I had been promoted with full benefits. I would look into that as well, not only trying to negotiate with the insurance companies, try to negotiate with your job offer.