Health Insurance Forum - Denied Insurance

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Q: Denied Insurance - Why???

asked by: Susan B on October 10th, 2007

New User

I really need some advice on this one, because I'm totally baffled. My family had private health insurance because we are self employed. Then my husband took a job with a large company, and we got their plan. The job didn't work out, so we applied again with our previous company, and I was denied.

Thing is, there has been NO change in my health! They denied me because of a visit I had almost 3 years ago (before we had this insurance the FIRST time). I was seen for pain in my shoulder. I had a cortisone shot, and my condition went away. No more pain, no symptoms since. But, my doctor had noted that if it didn't get better, I might need surgery. Well, it DID get better, and I didn't and won't need any surgery. All this was in my records 2 years ago when we first got private insurance. Now they are flat out turning me down, AND saying they shouldn't have covered me before...that it was a mistake.

Isn't it true that ANY condition might need more treatment if it doesn't get better? I'm fine. I have no health conditions whatsoever, am a healthy weight, young...and I'm not insurable? They won't just do a rider because by Michigan law, it's been too long. That's a tip right there that this isn't right. Now I have a denial on my record. I'm afraid to start applying elsewhere and screw things up more. (The last time we checked with a different company, my son got a denial because of ADHD) Any suggestions from anyone? - Sue

Replies(6)

TMJWorld

replied on October 10th, 2007

Extremely eHealthy

it may be because you have had a lapse in the time that you had insurance. Im not quite sure what to do.

Mabel

replied on October 10th, 2007

Supporter

Contact the insurance company that denied you and ask them to explain their denial policy to you. Also ask them why they covered you before but refuse to now.

Rosie H

replied on October 10th, 2007

Extremely eHealthy

the worst thing you can do is take their word for it. Call them back and demand an explanation. Ask if its in their contract with people who are selfemployed. They owe you a better answer.

Venn

replied on October 18th, 2007

New User

They've denied you because they've decided that such a condition could return and worsen, based on the condition type.

Health insurance companies only want people who have an extremely low chance of filing a claim. They're in a highly competitive business with each other, and the only way they can control their costs is by cherry-picking only the healthiest applicants. Your only option unfortunately may be your state's high risk insurance pool.

You should however apply to other insurance companies first, as whatever you have may not be treated the same. There actually is variation company-to-company for lower risk conditions. (I'm not sure if what you have is considered low risk.) For example, some companies will accept people who have high cholesterol; others won't.

Estreetloans

replied on November 8th, 2007

New User

What Venn says is sad but true. Insurance companies need to make money and so they insure the people least likely to actually use the policy.

With your shoulder issues you have become a higher risk to insure. Although you may think that your shoulder is fine, one slip could cause severe injuries.

You do not have to accept that they denied you however. Confront the company and demand answers. You paid them good money to be insured by them and they owe you a bit of explanation. Good luck to you!

charduck

replied on November 21st, 2007

New User

I Had Similar Situation...

I went through a similar situation a couple years ago. My husband is insurable, but I am not. For me, it's because I'm on an expensive medication for a non-life-threatening condition. They turned me down because of the cost of the meds! My husband ended up getting insurance, but after rejection after rejection, I signed with a discount health care plan that actually isn't bad. If you have lots of serious conditions, of course, insurance is better. But if you see doctors infrequently, you may want to check it out.

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