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
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Tmddyan
Moderator
Joined: 13 Jun 2006 Posts: 4346 Location: post falls, id usa
Thanks: 93
Thanked:63
Posted: 10-10-07 12:09pm
it may be because you have had a lapse in
the time that you had insurance. Im not
quite sure what to do.
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Ingi
Moderator
Joined: 09 Mar 2006 Posts: 8768 Location: Grinning like a Cheshire Cat,
Thanks: 161
Thanked:194
Posted: 10-10-07 12:16pm
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.
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Rosie H
Extremely EHEALTHy
Joined: 11 Jun 2007 Posts: 1118 Location: Phoenix, AZ, USA
Thanks: 15
Thanked:5
Posted: 10-10-07 12:19pm
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.
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Venn
New User, Becoming EHEALTHy
Joined: 18 Oct 2007 Posts: 14
Posted: 10-18-07 06:10am
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.
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Estreetloans
New User, Becoming EHEALTHy
Joined: 09 Oct 2007 Posts: 2 Location: Woodbrige, CT, USA
Posted: 11-08-07 17:01pm
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!
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charduck
New User, Becoming EHEALTHy
Joined: 11 Jan 2007 Posts: 10 Location: AZ
I Had Similar Situation... Posted: 11-21-07 18:06pm
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.
