Question on Obtaining Private Health Insurance

[Martha]

Good topic. What are people's experiences in working with agents to help you find an individual policy? Did you find that they have a good feel for what may cause a rejection or exclusion?

[Dawg52]

Originally Posted by Martha

Good topic. What are people's experiences in working with agents to help you find an individual policy? Did you find that they have a good feel for what may cause a rejection or exclusion?

I had a liver flair up at 40(no problems since) and was on cholesterol meds when I applied. I was applying for coverage that held our company plan so may have felt they would have less exposer with my high ded(10k) over our company plan. But even so, my agent thought I had a 50/50 chance.

[Oldbabe]

Originally Posted by Martha

Good topic. What are people's experiences in working with agents to help you find an individual policy? Did you find that they have a good feel for what may cause a rejection or exclusion?

My agent has been very helpful. She told me upfront that almost all insurance companies would exclude the basel cell from coverage. She has also recommended certain companies and helped me to navigate the byzantine process.

[free4now]

I was originally rejected for BC life private insurance, but after doing an appeal that involved a couple of rounds of back and forth, and lots of keeping on top of them, I got the policy. In some sense I think it's a war of attrition. If you just keep on them and don't take no for an answer the schlub in India or wherever might eventually just get tired and approve you.

[Oldbabe]

Originally Posted by free4now

I was originally rejected for BC life private insurance, but after doing an appeal that involved a couple of rounds of back and forth, and lots of keeping on top of them, I got the policy. In some sense I think it's a war of attrition. If you just keep on them and don't take no for an answer the schlub in India or wherever might eventually just get tired and approve you.

I doubt that any US health insurance company would hire an underwriter from a foreign country. That would be outrageous!

[sgeeeee]

Originally Posted by RASAP

...

What types of “minor” conditions cause an insurance company to reject or your application or increase the premiums significantly? . . .

When DW and I applied for insurance ~3 years ago, I was surprised by the reaction of BCBS of Arizona to my hernia surgery almost two years prior to the application. The surgery was minor laproscopic surgery without complications and I have had no problems since. BCBS agreed to insure but with any future hernia problems not insured. I asked them if I got a rebate since I would be getting less insurance than other people. You can guess the answer.

[Sheryl]

Originally Posted by sgeeeee

BCBS agreed to insure but with any future hernia problems not insured. I asked them if I got a rebate since I would be getting less insurance than other people. You can guess the answer.

So what exactly are we expected to do if pre-existing conditions recurr? Self-insure? If the things that are most likely to cause me future health problems are excluded, why not self-insure for everything (other than catastrophic care?)

I'm confused.

[Mr._johngalt]

Originally Posted by Sheryl

So what exactly are we expected to do if pre-existing conditions recurr? Self-insure? If the things that are most likely to cause me future health problems are excluded, why not self-insure for everything (other than catastrophic care?)

I'm confused.

This was never too much of a problem for me as most of my "pre-existing"
is chronic anyway and is not going away (no cure). Once though
I got a quote (forget what company) that not only specifically
excluded a bunch of pre-existing, but also any injury due to operation
of a motorcycle. Since that was my main hobby at the time (and obviously
dangerous) I had to pass.

JG

[Oldbabe]

So, the latest on my journey toward acquiring individual health insurance is another rejection. First rejection from Kaiser HMO, no reason. Second rejection, Humana One, for abnormal test result, which was a cholesterol reading of 234. They wrote "including but not limited to", so it could have been more things too. My agent says it was likely the degenerative cervical disk, caught on an x-ray four years ago which has never given me a moment of trouble since then. And by the way, 90% of all people over 50 have some degeneration in the cervical disk area.

No one can believe I'm having so much trouble. I really have very little wrong with me. I exercise regularly, eat healthy food, and am NEVER sick.
But I have had borderline high cholesterol, a degenerative disk, and a few skin cancers. So I'm uninsurable by those companies.

So it goes. My agent is pre-screening me for three companies next week. She says that she still thinks she can get me insured. If I don't get accepted by any, I go into the state high risk pool, probably with a deductible of $10K. Luckily, I can "afford" health insurance, even under these conditions. Most people cannot. Such is the great health safety net we have in this country.

[Mr._johngalt]

Originally Posted by Oldbabe

So, the latest on my journey toward acquiring individual health insurance is another rejection. First rejection from Kaiser HMO, no reason. Second rejection, Humana One, for abnormal test result, which was a cholesterol reading of 234. They wrote "including but not limited to", so it could have been more things too. My agent says it was likely the degenerative cervical disk, caught on an x-ray four years ago which has never given me a moment of trouble since then. And by the way, 90% of all people over 50 have some degeneration in the cervical disk area.

No one can believe I'm having so much trouble. I really have very little wrong with me. I exercise regularly, eat healthy food, and am NEVER sick.
But I have had borderline high cholesterol, a degenerative disk, and a few skin cancers. So I'm uninsurable by those companies.

So it goes. My agent is pre-screening me for three companies next week. She says that she still thinks she can get me insured. If I don't get accepted by any, I go into the state high risk pool, probably with a deductible of $10K. Luckily, I can "afford" health insurance, even under these conditions. Most people cannot. Such is the great health safety net we have in this country.

Now, this is why I love this forum...........even when I just drop in for
a "lurk-look" (not logged in), something pops up that I can't resist.
(For anyone wondering, my internet provider is paid thru mo. end)

Oldbabe, I feel your pain (been there - done that). In my experience it
takes very little neg. history to get rejected. The insurance companies want to insure healthy people (can you blame them?). Re.
"great health safety net", yep it is a mess. Of course, in my case, I
have zero confidence in the government fixing it, ever! I will go further.
I prefer my current situation (very like yours) rather than have the government "fix" it. This is true even if it costs me money and time.
Such is my complete contempt for
"government solutions" (oxymoron?) and my faith in free
markets. Allow me to state it another way. I prefer to struggle and
sweat bullets over health insurance than to add more federal
taxes/bureaucracy, even if it saved me money. I am pretty sure
Milton Friedman would have agreed.

JG

[Martha]

John, let's not make this a political thread. If it goes that route, I'll split the topic.

Oldbabe, keep us informed. I you are successful on the individual market I would be interested in who knowing who is the insurer.

[Sheryl]

Originally Posted by Oldbabe

So, the latest on my journey toward acquiring individual health insurance is another rejection

Hi Oldbabe - I'm really sorry to hear you're having all this trouble. It seems a little bit extreme that they're rejecting you for such simple issues. I'm sorry for selfish reasons as well, because it only solidifies my belief that I'll NEVER get individual insurance if I ever set foot outside the protective COBRA bubble.

What a mess. Please do keep us informed on your progress.

[Mr._johngalt]

Originally Posted by Martha

John, let's not make this a political thread. If it goes that route, I'll split the topic.

Oldbabe, keep us informed. I you are successful on the individual market I would be interested in who knowing who is the insurer.

Sorry Martha. I tend to use a lot of threads as a segue into a political
rant. Gotta love the passion though, right?

JG

[mb]

Ah crap, another reason to worry about if I can RE or not

Just curious to see if any others have had experiences like sgeeeee?

Originally Posted by sgeeeee

When DW and I applied for insurance ~3 years ago, I was surprised by the reaction of BCBS of Arizona to my hernia surgery almost two years prior to the application. The surgery was minor laproscopic surgery without complications and I have had no problems since. BCBS agreed to insure but with any future hernia problems not insured. I asked them if I got a rebate since I would be getting less insurance than other people. You can guess the answer.

I suspect that I could have a similar problem?

I have always considered myself to be pretty healthy but a couple of years ago I went to the hospital on a monday after a terrible weekend in which I couldn't keep food down and found myself being wheeled into surgery an hour later to fix a blocked intestine.

Everything has been fine since then but the last thing that the MD told me before I left the hospital was that I was an anamoly and that they still didn't understand the root cause.

MB

[REWahoo]

Originally Posted by mb

Ah crap, another reason to worry about if I can RE or not

Just curious to see if any others have had experiences like sgeeeee?

Based on DW's experience, you can expect to have any problem related to your intestinal condition excluded from coverage. Do you have a state high risk pool? Due to the exclusions, we ended up going that way to get insurance for her. Cost is double my premium for the same basic coverage, but no way are we willing to risk the exclusions.

[mb]

Thanks REWahoo,

I haven't looked into post-retirement health insurance. I live in CA. Don't know what is available here?

MB

[REWahoo]

You can check out your state's insurance offerings here: www.healthinsuranceinfo.net

BTW, some states don't allow insurers to exclude pre-existing conditions, resulting in very (sky) high premiums. The link above is to a site run by Georgetown University and is the best source available to begin understanding what your options are.

[Martha]

MB, I believe that if you are HIPAA eligible California requires mandatory acceptance by all individual insurance carriers without exclusions for preexisting conditions. They have to offer at least two HIPAA compliant policies. However, insurance companies together with the state sets the rates and they may not be affordable. If that is the case there is a risk pool for California residents who have used up their COBRA. I don't know the applicable rates; they differ depending on your age. You can stay in the risk pool for three years and then you have rights to go into the individual market. Avoid the risk pool if possible, there is a yearly cap of $75,000, with a $750,000 lifetime cap.



See, http://www.healthinsurance.org/calif...poolinfo.lasso for info on the risk pool.


HIPAA eligibility is defined here: http://early-retirement.org/forums/i...6148#msg186148