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Healthcare insurance troublemaker
Old 06-07-2007, 03:21 PM   #1
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Healthcare insurance troublemaker

Is what i'm thinking of becoming. This is pretty interesting...

Just for kicks, I applied for a family policy to the same HMO that I used to have, that is also the probable option we'll end up taking once my wifes employer straightens out her health benefits.


Oddly, they accepted my wife but not me, not having any concern about her preexisting conditions.

But they didnt like mine.

Citing the same oddball liver test that went away on a retest (and which THEY did), and my high triglycerides (same level as when I was with them as a health provider), they declined me coverage.

Soooo...even though its going to be a non-issue in a little bit...I'm terribly tempted to call them up and ask the "when did you stop beating your wife" question:

"So, since these situations were in evidence when I was covered by your policy previously, and I was told they were absolutely non issues and no treatment was recommended or offered...did you give me poor health care then or are you rejecting me for BS reasons now?"

I honestly expected them to reject us, but for my wifes asthma and $250-300 a month prescription bill. But I thought there might be an odd chance that they'd accept us and we could dump our $1400 a month Cobra for a $800ish HMO bill, then when the wifes benefits kick in (whenever that is), we could switch from an individual/family plan to their group plan, keep the same doctors, yada yada yada...

So ... push it or spend my time on other pursuits? What are my odds of overcoming this...especially considering they're a little bit "on the hook" for telling me in 2003-4 that the test was bogus and that the high triglycerides (with good HDL and LDL readings) was just something they'd want to monitor.
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Old 06-07-2007, 03:45 PM   #2
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Might not hurt to push it - to get the acceptance even if you don't end up with it. Your circumstances could change down the road and you might want insurance from them in the future. Or you don't want a record of their "turn down" in the big database in the sky for other companies to reference.

Also - what was the outcome of the employer thing - are they going to do the right thing?
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Old 06-07-2007, 03:48 PM   #3
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I figured to mess with them at least a bit. Unfortunately I have to do it in writing...its far more fun to listen to someone wriggling on the other end of the phone.

According to the employer "the computer just CANT do it!"...anyone besides me ever hear of a setup like that where they have problems ALL the time (according to the benefits guy) and theres NO manual override? Me neither.

So basically they unemployed her for a day and then reemployed her, which supposedly will reset her eligibility clock and make her eligible for July 1.

Allegedly.
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Old 06-08-2007, 07:07 AM   #4
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Hmmmm, I might still try to push the individual application, just for grins. You don't have to take it later if you finally get accepted, 'cuz there's usually a "free look" period. For grins, and I don't really even know how much info you want to give, but, which carrier did you apply with, and what kind of liver test was it? Did you make sure to cite that the test later came back normal and has been normal ever since? Did you send in copies of the normal test results with the application? How high are the triglycerides, and is there any way to keep that figure under control with medication or diet and excercise? What is your risk factor for heart disease later on in life based on your Triglyceride numbers. IMO, it could actually be the triglycerides that are causing the decline, but whenever insurance carriers send a decline letter, they always cite ALL pre-existing conditions in the list, even if some of them wouldn't have been the breaker. For example, I once had a client with multiple minor pre-existing conditions and a history of alchohol abuse. Although all of her conditions and the alcolhol abuse were cited in the decline letter, the ONLY thing that led to the decline was the alcohol abuse history.
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Old 06-08-2007, 10:01 AM   #5
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The carrier is Kaiser Permanente. The test (done by them) was a regular blood panel with my physical. I forget what it was but some liver enzyme that was supposed to be something like between 30 and 50 and it was a 52, then on retest went back to a 40 and stayed there. They ultrasounded half my body and said "no problem". My PCP told me not to worry about it, it was just a goofy blip, probably something went wrong with the test.

My triglycerides are between 225 and 400, against an hdl/ldl total cholesterol thats around 125. Its genetic. My dads run north of 400-500, he's 73, eats like a vegetarian bird, walks 8-10 miles a day, and is thin as a rail. My grandfather lived to nearly 90, ate bacon and eggs every morning and spread the bacon fat on his toast because it was tasty, cheaper than butter, and we cant have anything go to waste. And while he worked a lot of manual labor jobs, he looked like a giant weeble. His was in the 400-500 range.

So it seems that based on this small but highly correlated sample size, the triglycerides will not limit my life span or dictate my health. And how I eat or exercise wont make much difference.

But all this is sort of an aside to me. All of these situations were in evidence when they insured me previously...and they neither told me they were a problem nor offered any treatment. So either they gave me bad medical care before, or are declining me for BS reasons.

Since I've had BCBS and a different PCP the last 2 years, and he also didnt have a big problem with my health...it seems its the "bs reasons" category.
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Old 06-13-2007, 11:07 PM   #6
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Cute and Fuzzy -

I know it's hard not to take underwriting decisions personally, but you have to remember that the underwriters don't know you from Adam, and just because the carrier insured you before, perhaps under a group, doesn't mean that the underwriters for the individual insurance have copies of every blood test and Dr. appt you've ever had, right at their fingertips. If you really want to get covered individually, I really do think it is possible, with a little bit of pushback. A simple copy of the medical records from the follow up visit explaining that the original test probably went wrong should do the trick. I can assure you that the underwriter does not have that information readily available, even though Kaiser had insured you before. The way to get the issue through underwriting is to contact the underwriter and ask them if you can personally fax them a copy of the medical records from the followup tests and examination. You should really think about getting a good broker on your side who has connections to the right people and who can get details on what the underwriters would need to get beyond the liver enzyme issue. I really don't think it's impossible. Now, as far as the tryiglycerides, go, I'd have to do some more research on how underwriters look at the numbers from a statistical "risk" standpoint, and how that affects underwriting outcome.

One thing a lot of people don't realize is that when they get a letter of declination from an insurance carrier, the insurance carrier will list ALL pre-existing conditions disclosed on the application as well as anything additional they may have found from the MIB or other sources in the paragraph detailing the declination. However, it might only be ONE or TWO of those things or a COMBINATION of the pre-existing conditions that led to the declination. To get down to the nitty gritty and find out what the real reason was for the decline, it sometimes helps to have a broker who can get to the right person and get info pinpointing the problem areas and then find out what it would take to resolve them if possible.

For example, I once had a healthy client who kept applying for coverage only to be declined. She couldn't figure out what the problem was. Finally, I was able to drag out of one of the underwriters that she had "cancer" showing up in the MIB. Of course, the client had no idea where it was coming from. We finally pinned it down to one doctor who had removed a freckle from her nose, but coded the claim as "basal cell cancer" instead of "cosmetic" so the insurance company would pay for it. After a few months, we were able to get the doctor to write a letter admitting to the error, and we were able to get her covered.
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Old 06-15-2007, 07:23 PM   #7
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I'm having the same problems with Kaiser - my wife got accepted and I was rejected twice for a single gall stone attack in 2004. On the second application, I was also rejected for unstable weight problem because my weight was 10# off from the first application from a year prior. Ironically my costs are $100 cheaper per month on Cobra than her cost. I plan on running out Cal-Cobra and maybe having them yank my gall bladder. While I have been happy with Kaiser doctors, the organization, probably not unlike all the others, is terrible. Any candidate from any party, who supports universal health care has my vote.
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Old 06-15-2007, 07:27 PM   #8
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I wrote them the "did you give me bad care or are you rejecting me for BS reasons?" letter. My wife and sons insurance cards came in the mail today.

We'll probably have group coverage before they get around to reading and responding to my letter, but it'll be fun to get someone to twist in the breeze a little bit.

Besides me.

A little under $500 to cover the two of them vs $1400 for cobra for the 3 of us. I'll go bare until the group coverage shows up. So no ladders, compressors, nail guns, etc. for awhile.
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Old 06-18-2007, 08:47 AM   #9
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Cute & Fuzzy -

Have you thought about purchasing a short term major medical plan to get you by until the group coverage kicks in, and it counts as creditable coverage for bridging "gaps".

Allied National doesn't care if you've previously been declined for individual coverage. They don't cover anything to do with pre-existing conditions, but it will protect you from anything that is not pre-existing. Here is a link:

StoreFront 6.0 - Home Page

There are only four or five qualifying questions.

MKLD
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Old 06-18-2007, 09:10 AM   #10
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Looks like an 80-90% chance we'll have the group coverage by the end of the month and 100% that we'll have it by the first of the next month...cuz she'll be working somewhere else that actually gives benefits if the current place doesnt straighten out.

The new group coverage has no preexisting conditions nor do they require any creditable coverage.

The place you pointed out doesnt offer coverage in california. And I'm a little 'sick' of paying exorbitant amounts to insurance companies.

Worst case if something crops up, I can overnight a check to the Cobra company.

Actually worst case is that the benefits people at my wifes work, who I believe couldnt find their own ass with both hands and a hinged swivel waist, make lots of noise about the certainty of coverage by the 1st and then dont come through again.
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Old 06-29-2007, 09:22 AM   #11
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I'm not sure if it was the "were you giving me poor healthcare then or are you rejecting me now for BS reasons" or the fact that nothings really wrong with me, but on reviewing my letter the HMO changed their minds and accepted me for coverage.

Yay! Bring on the compressors, nail guns, radial saws and 25' ladders!!

So it seems it pays to be persistent.
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Old 06-29-2007, 10:11 AM   #12
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Originally Posted by cute fuzzy bunny View Post
I'm not sure if it was the "were you giving me poor healthcare then or are you rejecting me now for BS reasons" or the fact that nothings really wrong with me, but on reviewing my letter the HMO changed their minds and accepted me for coverage.
I'm really glad that it worked out this way.

You are young, in essentially fine health, got to plead for health insurance from your carrier, and are now empowered to pay $10k a year for coverage. For now.

Is this a great system or what . Stay well.
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As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
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Old 06-29-2007, 11:17 AM   #13
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congrats cfb! i think they depend on most people not being persistant!

but you caught em w/ their pants down he he
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Old 06-29-2007, 12:12 PM   #14
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congrats cfb! i think they depend on most people not being persistant!

but you caught em w/ their pants down he he
How did you know? Insurance companies really don't want to sell health insurance to anyone. They love to waste their time and money making people send letters refuting their underwriting decisions! I mean come on - after all, they have your whole life right in front of them, they can see that you're healthy, but they just don't want your money...they'd rather make you fight to give them money in return for coverage that they know you'll never use. ...give me a break.
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Old 06-29-2007, 12:14 PM   #15
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Old 06-29-2007, 01:17 PM   #16
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Hmm..since they covered me for insurance for over four years...just a couple of years ago, they sort of DID have my whole life right in front of them.

Yep Rich, its a great system. And I cant wait for it to get thrown out of a window.

At least I only have to pay them for a month, when allegedly the wifes benefits (with the same carrier) kick in.

$800-something a month still beats the whizdoodle out of $1340 to cobra for lesser coverage.
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