Insurance Coverage Denied

MNSusan · June 2013

My husband retired last year and now has Medicare coverage. I've been on his COBRA policy since then and it ends June 30. At the suggestion of an insurance broker, I applied for a individual policy through the same company. I received a letter yesterday saying my application has been denied due to recurrent breast cancer.

I know there will be options for me starting Jan 2014 - it looks like I have to go without between now and then.

I had my exchange surgery May 16 and I'm doing well. My PS doesn't need to see me for 3 months, my MO says 6 months. I guess I'm not overly concerned about that - I can pay out of pocket if I need to see either of them - but what about an accident? My stomach gets tied in knots thinking we could lose everything if I was involved in a terrible car accident or something.

I'm going to spend the day trying to see if there are any other options. So far, I don't see any.

If anyone has a suggestion, I'd love to hear it.

Golden01 · June 2013

Some states have high risk pools for medical insurance. My brother-in-law is the in the program in Nebraska: http://www.naschip.org/states_pools.htm. Coverage is expensive but he has it! We are counting the days until October 1 to see what his choices will be come January 14.

Here's the link to find out about other states: http://www.naschip.org/states_pools.htm

One other thought, are there any other options through your husband's retiree benefits or through any professional associations?

MNSusan · June 2013

We're residents of Florida although we spend the summer months in Minnesota. FL doesn't have a pool and discontinued their PCIP (pre existing condition ins program). Medicaid has a program with higher income allowances for women with breast and cervical cancer, but from what I've been able to find so far, that program is for treatment of those diseases, not general coverage.

My husband has no retiree benefits from the job he retired from (we checked that last year when I picked up his COBRA). Coverage through a professional assn is interesting. He's a physicist but worked the last several years in management. I'll check with him. He does receive a couple of VERY small pension payments from jobs long ago. There might be something there.

I checked the American Cancer Society but it just lists options. I haven't been able to see where it has any coverage. AARP uses the same company that denied me. I'm off to check Komen next.

Thank you for your suggestions!

Golden01 · June 2013

One more idea, in Arizona where I live, the Area Agency on Aging has a staff person that does nothing but help people sort out the medical insurance options. It would not over policies but might know of some possibilities for you. Since you summer in MN, can you be in that high risk pool? COBRA ending is usually a reason you can be included.

MNSusan · June 2013

Thank you so much, Golden.

I think the MN high risk pool will be the answer. I just got off the phone with them and it sounds like I'll qualify. Since my husband retired, we've been changing our residency to FL, but we still have our homestead credit on the house in MN and still have banking, etc. here. The only significant change is that we have FL drivers licenses but the woman I spoke to said as long as I could say that the MN residence is my principal residence for the next six months, I'm good. The program goes away as of 1/1/14.

You're right, the premiums are REALLY high but we can play with the deductibles to get something into a range we can live with. I'm so glad I'm not in the middle of treatment!

This site really is amazing, and I thank you SO much for taking the time to respond to my post. Great big hugs to you and a smooch, too! Mwuah!

BrooksideVT · June 2013

It is possible that your COBRA insurer has an individual conversion option, which cannot refuse you, and that you've accidentally applied as a new applicant. Please do check asap that you have filed the correct paperwork. THese companies have multiple forms for multiple situations and it is very easy to either have the wrong form or to check the wrong box. The correct form should ask for your COBRA info.

MNSusan · June 2013

That's interesting, Brookside. The COBRA insurer is UnitedHealthcare and they're huge. The broker I spoke to sent me an email with a link. I did the application online and its very possible I checked the wrong box or something. I think I'll call them. THANKS!

MNSusan · June 2013

I called and found out that indeed I qualify for a "Portability Plan" and they can't deny coverage. The premium will be in excess of $800/mo for a $5000 deductible plan, which is a lot more than the MN program, but they couldn't give me an exact quote until the application goes through Underwriting. They'll let me know within 7-10 days.

Thank you Brookside! With all the talk of Obamacare, there are still a bunch of us hanging out here wondering what on earth to do until that time comes. It'll be interesting to see what happens come 10/1 when enrollment for that program opens up.

BrooksideVT · June 2013

I'm so glad there's an option, but, boy, expensive! It's been a long time since I thought about this, but it seems to me that all COBRA plans have to offer conversion to an individual plan. I'm so glad I could help!

wanderingstar · June 2013

Make sure you call the human resources where he worked. I got cobra from them when my husband went on social security for an additional 3 years. The cost was what it was costing the company for all employees. I paid the premium to the company, not United Healthcare. Just call them because they may be able to handle it at a lower cost. Then when the cobra ran out I was entitled to get on the national plan for pre existing conditions.

Golden01 · June 2013

I remembered something more from when my son was on COBRA through my work and he "aged out". He would be eligible to buy continued coverage with no pre-existing condition restrictions after he had been on COBRA (he has a genetic bone condition) as long as there was no break in coverage between the two plans. My HR person was adamant that we not delay in getting the post-COBRA plan in place. Turns out, he got a job with insurance so we didn't have to go through with getting him a policy. The key was that it was a "group" plan to "group" plan. Good luck to you.

MNSusan · June 2013

I think that's probably the individual conversion plan that BrooksideVT mentioned. That plan is available to me and they'll let me know the cost within 7-10 days. If the actual cost is close to what they guesstimated, the MN high risk program will probably be a better deal.

Another thing I was thinking about... I've already met the deductible for my COBRA policy this year. If I go the high risk pool route, I'm pretty sure I'll need to start over again. If I do the conversion plan, I wonder if they'd "roll over" the deductible amounts I've already paid.

My head hurts but I don't feel as panic-y as I felt earlier. Thanks ladies!!

soccermomof4 · July 2013

Christian Healthcare Ministries is an option for believers who faithfully attend church. No one is denied. It does not work like a regular insurance, you submit your bills & then they post your need & the funds come to you. Your amount has to be over $500 for that day, if it is under that you are responsible for it.

If you have more questions, you can look at their website. I was on this for awhil, when my husband lost his job & I have family memebers on it now & their bills have been covered.

Lewtop · July 2013

Aetna (my insurance company) approved my lumpectomy but now decline my breast reconstruction. Denied as cosmetic but reconstruction includes removing scar tissue as well as possible Injections of fat/stem cells which promote healing.

Does anyone have advice how to work with surgeons/plastic surgeons to gain approval for reconstruction/repair.

MNSusan · July 2013

Lewtop, down a little further in this section there's a thread titled, "Women's Health and Cancer Rights Act and lumpectomy." A staff attorney from the Cancer Legal Resource Center wrote a response there that might be helpful to you. Good luck!

http://community.breastcancer.org/forum/113/topic/805741?page=1#idx_3

Insurance Coverage Denied

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