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My wife
Old 02-25-2007, 12:49 PM   #1
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My wife

Hi friends,
Well the retired life is pretty darn sweet. I am doing odd jobs here and there just to keep my brain sharp. All was going well until we got word that my wife was turned down for health insurance. She is healthier than I am but she has bronchitis at least once a year. She is a non-smoker and takes great care of herself at age 51. So instead of around 300 bucks a month for her we are looking at double or more. Any suggestions? We are in Washington State. Thanks for your help.
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Re: My wife
Old 02-25-2007, 01:59 PM   #2
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Re: My wife

Quote:
Originally Posted by Epiphone
Hi friends,
Well the retired life is pretty darn sweet. I am doing odd jobs here and there just to keep my brain sharp. All was going well until we got word that my wife was turned down for health insurance. She is healthier than I am but she has bronchitis at least once a year. She is a non-smoker and takes great care of herself at age 51. So instead of around 300 bucks a month for her we are looking at double or more. Any suggestions? We are in Washington State. Thanks for your help.
Are you still covered by employer or Cobra? Are you Cobra eligible, or have you recently completed your 18 months of Cobra?

If certain conditions are met, you are guaranteed issue without even answering the health questionaire. Consult a good broker.

Ha

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Re: My wife
Old 02-25-2007, 03:31 PM   #3
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Re: My wife

Epiphone,

You need to learn about this quickly, as one of the conditions to being accepted to the Washington State High Risk pool is an insurance coverage rejection within the past 90 days. Or, she can be HIPAA-eligible, which is federal law that covers this area. Here is more information on Washington: http://tnhis.com/wa.htm

To be HIPAA-eligible, she roughly needs:

1) 18 months continuous coverage with no break > 63 days
2) most recent coverage must have been group coverage
3) must not be eligible for other group plan, medicaid, or medicare
4) she must have no other health insurance
5) must not have lost coverage due to non-payment or fraud
6) must have accepted and exhausted COBRA benefits if they were offered to her

You should spend some time researching this and understand your options. Don't put it off.

You should probably contact an insurance broker, too (they are free, know about insurance company underwriting preferences, etc.). Now that she has a rejection, it will go on her MIB record (www.mib.com). You should find out *exactly* why she was rejected, you can request this for free from the MIB site. YOu will have to disclose the rejection on all future health insurance applications for the rest of her life. Sometimes rejections are caused by incorrect information from a doctor (or a misunderstanding), etc.

Based on your description, she will probably be able to get private insurance, just not at the preferred rate. You don't necessarily need to get insurance together as a couple. An insurance broker can advise.

I will add that I will probably be applying for coverage next month in California. In order to be precise in my descriptions, I ordered all of my medical records so that I have them in front of me during the application process (taking me 2-3 weeks to get them). Inaccurate information can void your policy later. And you probably only want to answer only what you need to, nothing more, and carefully use language when describing ailments (medical records can be a guide). Again, insurance broker can help there.

Kramer
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Re: My wife
Old 02-25-2007, 07:18 PM   #4
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Re: My wife

I would reiterate what HaHa said. If she is HIPAA eligible (and Kramer posted the requirements) she doesn't have to go into the Washington state risk pool but is eligible for individual insurance with no underwriting.

If she is not HIPAA eligible, she may be eligible for the risk pool but if she has had a break in coverage she may have a pre-existing condition waiting period.

I suggest reading about rights in Washington in this guide, www.healthinsuranceinfo.net. This guide says that if you are HIPAA eligible:

You do not have to take a health questionnaire and must be offered an individual policy if you are HIPAA eligible. If you are a HIPAA eligible individual, you qualify to buy an insurance policy from an insurance company selling individual health insurance. Insurers must offer you a choice of all the individual health insurance policies they sell, unless they elect to make a choice of only two policies available to HIPAA eligible individuals.

In addition, where you are HIPAA eligible, you can also buy individual coverage from WSHIP (the risk pool), if you prefer.
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Re: My wife
Old 02-25-2007, 07:35 PM   #5
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Re: My wife

Quote:
Originally Posted by Epiphone
Hi friends,
Well the retired life is pretty darn sweet. I am doing odd jobs here and there just to keep my brain sharp. All was going well until we got word that my wife was turned down for health insurance. She is healthier than I am but she has bronchitis at least once a year. She is a non-smoker and takes great care of herself at age 51. So instead of around 300 bucks a month for her we are looking at double or more. Any suggestions? We are in Washington State. Thanks for your help.
This is the kinda garbage that makes me nuts.

Health insurance?? 600 a month in america Its all Bull!

We allow this to happen we elect @sses and then wonder why the greatest country on the planet cannot or will not take care of its own people.
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Re: My wife
Old 02-25-2007, 08:04 PM   #6
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Re: My wife

I would talk it over with your PCP before going into the risk pool. (If you have a choice). Mine told me that the coverage is terrible (in WA).
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Re: My wife
Old 02-25-2007, 10:16 PM   #7
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Re: My wife

Epiphone,

Which carrier was she turned down with? I wouldn't give up yet. Different carriers have different underwriting guidelines, and some are more lenient on bronchitis as others. Was it chronic bronchitis or an acute case? It's very important to specify acute vs. chronic on the application, because chronic bronchitis signifies the risk of asthma or other respiratory disorders that present a high risk to insurance carriers.

Did she apply for a high deductible plan or a full coverage copay plan? Some carriers are more lenient with underwriting guidelines on high deductible plans than others. Also, have you considered appealing the decline? Sometimes, a simple doctor's note explaining the prognosis and outcome is all that is needed to be accepted. Are you sure there wasn't something else in the medical records that was discovered during underwriting that could have caused the decline?. Because an acute case of bronchitis usually doesn't result in a decline. Did your wife call the insurance company and ask for the specific reason for the decline? Because of HIPAA, the underwriter will not send the details in a fax or speak to anyone but the person who applied.

I would do the following. Get the specific reason for the decline. If it really was just the bronchitis, I would find a broker who can do some prescreening and find a different carrier that will be more lenient with the underwriting on that. I would try with several carriers before giving up.

I found this information on the nahu.org website:
"Carriers in Washington's individual health insurance market are required to guarantee issue coverage to medically qualified people and individuals exercising their HIPAA group-to-individual portability rights. The use of elimination riders is not permitted. "

http://www.nahu.org/consumer/healthcare/state.cfm

Just so you know, whenever the state governments mandate that private insurance carriers are not allowed to use elimination riders exclude certain conditions (such as bronchitis) from coverage, there is a much higher liklihood that people will be declined, even for minor conditions. Take away the government mandates, and all of a sudden, competition comes back into the marketplace, prices drop, and more people are able to obtain coverage. In Colorado, insurance carriers are allowed to use exclusion riders so that they can offer coverage without being responsible for certain pre-existing conditions. I have a couple of minor riders on my insurance policy. I think that's only fair, since I didn't buy the insurance until after I had the conditions. Since they are minor and cost very little for me to pay out of pocket, I would rather have the exclusionary riders than no coverage at all. If my state was not allowed to rider my pre-existing conditions, I probably would have been declined just as your wife was.
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Re: My wife
Old 02-26-2007, 09:03 AM   #8
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Re: My wife

Quote:
Originally Posted by newguy888
This is the kinda garbage that makes me nuts.

Health insurance?? 600 a month in america Its all Bull!

We allow this to happen we elect @sses and then wonder why the greatest country on the planet cannot or will not take care of its own people.
$600 a month ISN'T all that uncommon outside of govt or state jobs........... :P :P
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Re: My wife
Old 02-26-2007, 07:59 PM   #9
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Re: My wife

I think my premium on our company plan is about $450, and if/when SO retires and I add him, his will be $529 (he's in an older bracket). So $600 for an individual plan doesn't seem so bad to me, depending on coverage, deductible, etc. of course.
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Re: My wife
Old 02-28-2007, 01:47 PM   #10
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Re: My wife

My wife's policy at work costs us about $400 per month for the kid and me. I don't know how much the company is paying for the wife. Either way it is still close to the $600 amount for the individual policy quoted.
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Re: My wife
Old 02-28-2007, 08:55 PM   #11
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Re: My wife

At 47, I pay $220 per month for DH and me - $5,000 deductible, no drug coverage, no office visits, no nothin... but I read that once you're in, you're in, which is a big relief to us.
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Re: My wife
Old 02-28-2007, 10:04 PM   #12
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Re: My wife

Quote:
Originally Posted by Sparky
At 47, I pay $220 per month for DH and me - $5,000 deductible, no drug coverage, no office visits, no nothin... but I read that once you're in, you're in, which is a big relief to us.
Are you sure you have no drug coverage or coverage for office visits? A lot of times, people mistake deductible expenses as expenses that aren't covered. Expenses that aren't covered will not reduce your deductible. Why would you buy an insurance policy that has no drug coverage?
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Re: My wife
Old 03-01-2007, 04:39 PM   #13
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Re: My wife

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Originally Posted by mykidslovedogs
Are you sure you have no drug coverage or coverage for office visits? A lot of times, people mistake deductible expenses as expenses that aren't covered. Expenses that aren't covered will not reduce your deductible. Why would you buy an insurance policy that has no drug coverage?
I'm sure that I have no drug coverage or office visit coverage... the reason I would buy a policy without those things is that I can cover out-of-pocket expenses - just can't cover a "hit by a bus" incident. I buy high cholesterol and high blood pressure drugs from Canada and/or from my former union and can purchase the occasional needed drug from CVS.
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Re: My wife
Old 03-01-2007, 05:02 PM   #14
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Re: My wife

Quote:
Originally Posted by Sparky
I'm sure that I have no drug coverage or office visit coverage... the reason I would buy a policy without those things is that I can cover out-of-pocket expenses - just can't cover a "hit by a bus" incident. I buy high cholesterol and high blood pressure drugs from Canada and/or from my former union and can purchase the occasional needed drug from CVS.
I'm not sure what CVS is (sorry for not understanding the acronyms). It seems to me that you may be wasting your money. The whole purpose of insurance is to plan for unforseen major medical expenses. There are many Cancer, Rheumatoid Arthritis, Multiple Sclerosis, Pituitary Gland, Endocrine drugs, Chronic pain treatments, and other types of drugs that cost in excess of $1,000/mo. If you were to come down with a major medical disease, such as any of those listed above, your policy is pretty much going to be worthless. Although it might pay for hospitalization, what are you going to do about expensive prescriptions and doctor office visits?

I always advise against purchasing policies with no prescription coverage.
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Re: My wife
Old 03-01-2007, 05:52 PM   #15
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Re: My wife

Quote:
Originally Posted by mykidslovedogs
I'm not sure what CVS is (sorry for not understanding the acronyms).
CVS is a drugstore chain, similar to Kerr, Eckerds, Walgreens, etc. Don't know if it covers all the US, but is definitely prevalant in the southeast where I'm from.
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Re: My wife
Old 03-02-2007, 02:48 PM   #16
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Re: My wife

Quote:
Originally Posted by mykidslovedogs
I'm not sure what CVS is (sorry for not understanding the acronyms). It seems to me that you may be wasting your money. The whole purpose of insurance is to plan for unforseen major medical expenses. There are many Cancer, Rheumatoid Arthritis, Multiple Sclerosis, Pituitary Gland, Endocrine drugs, Chronic pain treatments, and other types of drugs that cost in excess of $1,000/mo. If you were to come down with a major medical disease, such as any of those listed above, your policy is pretty much going to be worthless. Although it might pay for hospitalization, what are you going to do about expensive prescriptions and doctor office visits?

I always advise against purchasing policies with no prescription coverage.
Well, with a lot of thought put into this purchase, we've decided that the best course of action is to protect our assets in the event of a major emergency ("hit by a bus" incident) (protection to $3M) and we'll roll the dice elsewhere. In our 40's with no family history of cancer, we'll take our chances with drug coverage at this time...
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