Turned Down for Health Insurance AGAIN!

[Suzanka]

Hello,
I am new to this site and am so excited that I found an entire group devoted to PCOS. I was diagnosed with PSOC thirty years ago! I lost a lot of weight in my mid 30's and without even trying became pregnant with my daughter. I have normal cholesterol, normal BP and am about 20 lbs overweight. I had a heart scan which shows no plaque. I do take Metformin. I am self employed and need to carry my own coverage for heath insurance. My rate has gone up so unbelievably high (I could buy a house for the payment) and I have a very high deductible. I have been applying for coverage from different carriers (5 in all) and they all have denied me for one reason only, PCOS. They state that regardless of the severity it is too high a risk factor to insure. I was wondering if anyone else has been in this situation and if so which company did you go with. I may have to move to Canada!! Thanks for your help and I'm happy to have found you.

[eww]

Hahaha. I'm not much help, but Canada would welcome you.

[enligh10dwon]

Wow that sucks and it is quite discouraging as I am in the market to purchase insurance...Have you tried Aetna? I had them when I was covered but lost my job thusly my coverage...The plan I'm thinking about applyin for is 126 a month but may vary due to medical history so I wont know the actual preimum until I apply the deductible is 2500 and office/specialist visit co pays arent subject to the deductible...It would suck so bad if they deny me coverage

[Suzanka]

Hi, I actually did try Aetna they turned me down. I have Anthem right now but they are SO expensive. To my Canadian friend, thanks for your sympathy. Canada really has it together in many way.

[KatCarney]

I don't think it's simply because you 'have' pcos, it's because you're actively being treated for it. I'm not sure what you're age is now, but there might be the 'fear' of them having to pay for fertility treatments...

Have you tried BCBS? That's who I have, and I'm self-employed.

[ShyChicagoGirl]

Sorry to hear that Suzanka, that has to be frustrating.

I remember looking at the cost for Cobra insurance once before I was married and it was upwards of $500 a month for just me!

I hope you find a solution!

[Merc]

Suzan, I have a insurance called Golden Rule.... Not the best coverage I have 1500 Deduc. but they have covered a lot for me.

[enligh10dwon]

Sorry to hear that Suzanka, that has to be frustrating.

I remember looking at the cost for Cobra insurance once before I was married and it was upwards of $500 a month for just me!

I hope you find a solution!

My cobra premium is 405.75...definitely not going that route

[KatCarney]

My cobra premium is 405.75...definitely not going that route

Cobra is high, but whatever you do, don't let your coverage lapse. That's when the real problems start. Things can get really hard with a lapse in coverage.

Also, if you have to visit the doctor while waiting for new insurance, try to get your doctor to refrain from putting anything related to 'pcos' in your records.

Techinically, it's not a disease, so you don't really need to have it noted in your records. Since it's a syndrome (ie a 'constellation' of symptoms), have the doctor simply note the individual issues (ie hirsutism, high cholesterol, etc).

That kind of stuff flies under the health insurance radar...

[deblynnc]

I don't think it's simply because you 'have' pcos, it's because you're actively being treated for it. I'm not sure what you're age is now, but there might be the 'fear' of them having to pay for fertility treatments...

Have you tried BCBS? That's who I have, and I'm self-employed.

I was going to recommend BCBS, too. That's who we have our coverage with. DH has a small business and got a group plan (there are 4 covered, including DH and myself). I remember getting a call with some questions about some stuff on my paperwork before they approved us, but they did approve it. The plan we have doesn't pay for any fertility stuff, so I guess that wasn't a 'concern' they had.

[CECE23]

have you tried any of the smaller insurance companies like beech street or multiplan? also how about humana?

[chrissy5828]

I was turned down for soley pcos. My denial letter said it was due to pcos. I have not found a plan that is decent with a decent price that would accept me. It didn't cover maternity for the fertility issues would not be an issue.

[enligh10dwon]

Ok so how exactly do they know we have PCOS? For those of you who got turned down, did you tell them about PCOS on the application? Or do they go back and check medical history? PCOS/IR is the only thing wrong with me

[Suzanka]

Thanks so much for all the advice and suggestions. I have put PCOS on my application everytime except once. I take Metformin which is why I can't skirt around the need to take it. I currently have BC/BS but my deductible is $3000 and my monthly payment is $497!!! It keeps going up. I have no other medical issues whatsoever. I am past pregnancy age so that can't be why they are turning me down. Medical Mutual stated a study that showed a very high rate of heart disease in those of us with PCOS. I have had a heart scan which showed zero plaque. My blood pressure and cholestoral are all normal. I will try some of those smaller groups that were mentioned. I really don't know where I will find the time, but I may have to go work somewhere part time just to have coverage that is reasonable. Thanks again for everyone's input.

[KatCarney]

Ok so how exactly do they know we have PCOS?

They don't. I can't stress enough. A PCOS diagnosis is one of EXCLUSION. (ie Doctors test for other things...nothing turns up positive, so they label it PCOS.)

At present, there's no way to tell for sure if a woman has pcos. All it is, for now, is a grouping of symptoms for which doctors haven't identified a treatment or cause.

For those of you who got turned down, did you tell them about PCOS on the application? Or do they go back and check medical history? PCOS/IR is the only thing wrong with me

It's a combination of things...either you put it in your application, or it appears somewhere in your records. (They look back through several years of medical records.)

Thanks so much for all the advice and suggestions. I have put PCOS on my application everytime except once. I take Metformin which is why I can't skirt around the need to take it. .

Technically, you don't take Metformin for PCOS. Metformin is not an FDA approved treatment for PCOS. You take Metformin (I assume) to improve insulin sensitivity - same as a person with type II diabetes, or at risk for type II diabetes.

Medical Mutual stated a study that showed a very high rate of heart disease in those of us with PCOS.

There's no way, at this time, for anyone to CONFIRM you have PCOS, so there's no way that they could apply that study to you.

Moreover, did the women in the study with the highest rate have the same 'vitals' you have? (no plaque, normal blood pressure, normal cholesterol, and within 20 pounds of 'ideal' weight)? I haven't even seen the study, and I'm confident the answer is, "No."