I had BC/BS of Texas for years at my job, and when I retired I converted to the BC/BS COBRA plan. I used up my COBRA and then applied for individual insurance with BC/BS and then got turned down because I have arthritis in my knees. Now, the only insurance I can get is the high risk pool for over $700 monthly. I can't afford that, so now I have no insurance at all.

How can they do this? If they can turn you down for an age-related condition such as arthritis, why do they even offer insurance to anyone over 50 at all? I am fairly healthy, and I know of other people who received insurance with heart problems etc. I was getting a fairly high deductible ($2500), so the chances of BC/BS paying out anything were remote.

The insurance industry is going to be a major issue in the upcoming elections for reasons such as this. The health care crisis has suddenly become a major issue with me.

Have any of you been turned down? What were the reasons (without invading privacy), and what did you do about it?

The insurance company is not your friend. They are in business to make a profit.

When Terry and I got married, I put her on my company insurance policy. No problem, height, weight, pee in a bottle and she was covered. A year later when we went on the road, I sold the business and converted the insurance policy to a private policy. They said nothgin changed, except that the premiums were a few dollars more and the bill came in my name and not the newspaper's.

Eighteen months later Terry was diagnosed with State 4 cervical cancer. She had shown no symptoms prior to that. The insurance company refused to pay for her medical treatments and cancelled her coverage.

They said the cancer was a pre-existing condition and there was a 24 month window for pre-existing conditions. Even though she had been covered, for 30 months total (first company policy and then the change over to a private policy) the fine print buried in the contract said that the clock started running all over again when we converted the policy! Now she cannot get insurance at a premium we can afford.

Just talked to an RV friend in Casa Grande who had a quadruple bypass last year. For the 8 years they have been fulltiming, he has paid just over $1000 a month for health insurance.

When he was taken by ambulance to the hospital in Casa Grande, and from there up to Phoenix for his surgery, somebody did not get permission from the insurance company, and there was no time to get a referral from their list of approved doctors, so they have denied the claim.

Now he has over $125,000 in medical bills. If he had been putting that $1000 a month in the bank instead of giving it to an insurance company, he'd have been better off.

Nick,

I am sorry that hear of your (Terry's) experience. First, I am glad that she is with us and pray that she is fully recovered. Second, did you think of consulting an attorney? As you stated, insurance companies are in business to make a profit. However, IMO some or most of them have unethical and illegal practices. Sometimes it takes outside help to keep them in line.

I appreciate your information regarding the sale of your business and transfer of policies to personal policies. I expect to be doing much the same thing within a year or two. I will definitely be looking at the pre-existing condition clause.

Regarding your friend, I also recommend an attorney. Maybe he is not covered, but he can probably get an attorney on contingency (no out of pocket cost). It sounds like he has nothing to loose and a lot to gain.

quote:

If he had been putting that $1000 a month in the bank instead of giving it to an insurance company, he'd have been better off.

I am afraid I must disagree on this matter. Most important, your friend was covered for 8 years. He may or may not have had benefits during that time (most likely he did), but just being covered is a major benefit. Even at 5% (which would be difficult to earn over 8 years in a bank or money market) he would not accumulate $125,000. Further, he would have needed to pay taxes on the earnings along the way, further reducing his available principal.

Personally, I only believe in insuring that which would be a devastating loss. I don't carry collision insurance (my vehicles aren't worth it). I don't carry life insurance (my death would not be a financially devastation loss), and I only carry major medical insurance with $5,000 deductible (each). However, I do believe that totally self-insuring for medical expenses is a mistake for most people. I certainly realize that their are circumstances where insurance is unavailable or very expensive. Each person must measure what they have to loose in the case of a major medical issue and what the cost of insuring that matter is (assuming that the insurance company lives up to the agreement).

quote:

Have any of you been turned down? What were the reasons (without invading privacy), and what did you do about it?

About 10 years ago (when we went full time) I looked into abandoning my very expensive group policy (Blue Cross) through my business and getting individual coverage (much less expensive for the same coverage).

At the time I was 51 and in excellent health, my wife was 48 and in excellent health and our son was 13 and in excellent health. All 3 of us were turned down for individual coverage. I was turned down because I had taken Vicodin for a brief period for a bicycling related injury (full recovery). My wife was refused coverage for a (IMO) ridiculous reason, and my son was excluded because of a serious (but fully recovered) hiking accident.

IMO, insurance companies are taking huge risks through the group policies where anyone can join. I believe that they are trying to adjust that risk by issuing individual policies to only those with a very low risk. Further, to reduce the cost of issuance, they exclude individuals that would be included with further (read that as $$) investigation.

My resolution (so far) has been to continue my expensive group policies. Over the years I have transferred much of the risk from the insurance company to myself (less coverage and higher deductibles), thus reducing premiums. At this point I may need to continue the group policies until both my wife and I are eligible for Medicare (4 years for me, and 6 for her).

I understand that owning my own (very) small business gives me an advantage for group health insurance that is not available to everyone.

Health insurance is a huge issue for most of us, and I do not pretend to have the answers.

quote:

I had BC/BS of Texas for years at my job, and when I retired I converted to the BC/BS COBRA plan. I used up my COBRA and then applied for individual insurance with BC/BS and then got turned down because...

In states other than TX and WI, which I believe are the two exceptions, this situation would be covered by HIPAA. Since TX already had a high risk pool, it was allowed to grandfather out. I don't remember WI's situation. In the other 48 states, HIPAA would require that your COBRA insurer provide an individual policy without consideration of any pre-existing conditions on terms substantially the same as what is offered in the open market (there are restrictions on premium upcharges etc). However, as is the case with most things, it is up to the consumer to educate himself and there are rules that have to be strictly followed. In no state, I believe, would the OP's situation be covered in that he says he applied after his COBRA expired. The rules are such that there is to be continuity of coverage which means one does not apply after the other has run out.

At any rate, one should not expect an insurance company to advise one of this coverage. Consumers who avail themselves of this generally have pre-existing conditions or are in an age group that are not a preferred group and since an insurance company is in the business of trying to have its risk pool as pristine as possible, condidates for HIPAA coverages (or high risk pool coverages), these consumers would not be a candidate that most insurers would want to insure under regular pricing guidelines. So, ins. co's would not volunteer this coverage and, in our experience, might even deny that they have such coverage such that a reminder from their state ins. commissioner might be needed. And all that has to be done on a timely basis because once you mess around long enough and are outside the federally mandated timeline, you are out of luck.

In the OP case, the political gripe he wishes to pursue would be with the TX legislature which was one of two states that successfully got themselves exempted from this protective federal legislation. They got the exemption because "they had a better plan already in place" (their high risk pool) which now apparently is no longer true.

Avan,

You seem to know a lot about this subject.

California has had a high risk pool since 1991. Isn't that prior HIPAA? Is CA excluded? I ask for a reason. As stated above, I had group coverage, tried to get individual coverage, and was excluded. I did not terminate individual coverage and go to COBRA, and maybe that is the problem. Just wondering.

At some point I may want to give up the company group policy and convert to an individual policy. However, if there is no cost benefit or the coverage is not available I will just keep the group policy going indefinitely.

quote:

In the other 48 states, HIPAA would require that your COBRA insurer provide an individual policy without consideration of any pre-existing conditions on terms substantially the same as what is offered in the open market (there are restrictions on premium upcharges etc). However, as is the case with most things, it is up to the consumer to educate himself and there are rules that have to be strictly followed.

Well, if no one tells you this, how in the heck are you supposed to find out (or even know that). My widows COBRA runs out next Monday. I'd love to find out what my options are...I've got a call into an independent agent in SD (my homebase state) but I suspect the premiums will be outrageous. I'd love to continue with my current carrier but had no idea that I might be able to.

quote:

However, as is the case with most things, it is up to the consumer to educate himself and there are rules that have to be strictly followed. In no state, I believe, would the OP's situation be covered in that he says he applied after his COBRA expired. The rules are such that there is to be continuity of coverage which means one does not apply after the other has run out.

When I said I used up my COBRA, I mistakenly led you to believe that I had let the COBRA run out before applying for an individual policy. That is not the case. I applied for the individual policy two and 1/2 months before the COBRA ran out.

I can well believe that Texas screwed the pooch on this one. The Texas Legislature worked it so that I am unable to get health insurance as a retired teacher since I retired early. Had I retired one year earlier, I would have been able to buy in to the program. But the year before I retired, they changed it so the only way I could get insurance through the Teacher Retirement Program was to have continued teaching til I was 63. By that time, I would have been incarcerated for killing a kid.

Wow...this is a great topic. I was planning to move to TX at the end of this year. It appears that I better get my insurance situation totally figured out before I commit.

Art, don't believe CA was grandfathered out of the HIPAA legislation. Do your research. Don't believe anything an insurance company tells you. If you have a question, call your state insurance commissioner's office and when you get an answer, memorialize it by return letter or email to the party. Since it crossed state lines between a HIPAA state and a non-HIPAA state (TX) and two ins commissioners were involved operating under different rules, I never did get a straight answer as to whether one's HIPAA guarantied coverage policy was transferable to another state that operated a high risk pool in lieu of HIPAA. Absent a definitive answer and unwilling to risk my guaranteed coverage to the much higher pool premiums, we terminated our TX domicile.

When I say don't believe an insurance company, I mean it. When my big name ins. co told me they didn't offer a guaranteed coverage policy under HIPAA guidelines, I knew they were wrong. I finally had my state ins commissioner contact them and they 'found' the coverage. Then they sent me an application to fill out. Looked at the application and there were all sorts of health questions - not the sort of thing you'd find on a guaranteed coverage policy. More calls - "oops, we sent the wrong application. Don't think there's enough time left to send another before your COBRA expires." 'Oops' indeed! Another call to the ins. commissioner resulted in a fax etc and we got it done.

I would never lie to an ins. company but I'd never volunteer one iota of information either. It certainly is a strange adversarial relationship camouflaged as a 'we're a friend standing ready to help you in your time of need.'

Avan...thanks for the information. I will need to investigate the TX domicile question and insurance coverage further. As I mentioned, I plan a move to TX later this year, so this is an important issue for me.

quote:

I would never lie to an ins. company but I'd never volunteer one iota of information either.

Unfortunately, in order to acquire insurance coverage, you need to complete a questionnaire that has detailed information of your entire medical life. I find it almost impossible to accurately complete one of these applications. My wife read an article recently that asserted that insurance companies were going back to original applications to see if there were any errors or omissions. The article said that several attorneys were starting class action lawsuits with the underlying premise that it is nearly impossible to totally and accurately complete the required form.

Jeff and Suzanne,

quote
But the year before I retired, they changed it so the only way I could get insurance through the Teacher Retirement Program was to have continued teaching til I was 63. By that time, I would have been incarcerated for killing a kid.
quote

Hey! If you were to be incarcerated you would have at least had some medical coverage. <G>


HamRad

We were fully qualified for HIPPA in Va. We had the same health coverage for the past 7 yrs. The company was too small to offer COBRA. You have to have a certain number of employees to offer COBRA. 20, 25?
But, the HIPPA law is in effect there and we were never without coverage, applied in time, etc.
The law says they have to offer the same type coverage, but they can charge 2x the rate.
Well, all we could get after much effort was a $5000 deductible policy for $1500/mo. This was nothing like the coverage we previously had.
We couldn't afford this.
We are in the group that has no insurance, even though Bill has a serious heart condition.
I don't know what we will do if more surgery, etc.
We can't get coverage...no one will cover Bill.
We get his RX filled at Sam's or Walmart for $4.
Health coverage is important...if you can get it and keep it.
Mona

We were both denied coverage for health insurance and could only get coverage through our state's high risk pool--at $1000 per month per person! Neither of us had had any significant health issues, but DH was denied coverage because of his weight and I was denied because of high blood pressure (which was under control with meds at time of application).

We weren't aware of HIPPA's 62-day time limit for getting guaranteed individual coverage after our COBRA expired, and we unfortunately procrastinated...not sure what difference that might have made. But I'd strongly advise anyone who currently has COBRA (or ANY kind of health insurance, for that matter) to do all you can to have another policy ready to go into effect as soon as the original expires! Once that 62-day time limit expires, the insurance companies will surely find some issue to deny coverage...they're only in business to accept premiums from the young and healthy. They don't want you if you're old, even if you're healthy.

Brenda

I'm going out on a limb here but if it helps one person it will be worth it.

When I lived in Las Vegas (2001-April 2006), I was a sales rep in the gift industry. This is an industry where nearly everyone is an independent contractor, so you don't have any "company benefits". Luckily my husband was with a large corporation and we had really good benefits. But, I had many friends in the gift industry who did not and were dependent on individual policies.

The Las Vegas Chamber of Commerce had a program for it's members. Since my friends were independent contractors, they were in essence a small business owner and could join the Chamber. The insurance company the Chamber used was good enough that most of my friends got their insurance through them. One friend had a tough time because of pre-existing conditions but she was able to get the insurance. If you have a small business check with your domicile to see if they have a similar program. In some cases, it might be worth setting up a domicile in an area that offers this if you can qualify. Some of the Escapees sell on E-bay so you are a small business. Check it out to see if there is something out there that can help you. Good Luck, Connie