What are the Effects of Having Health Insurance Denied?

[John Galt III]

Hello all,

I'm 58, male, currently unemployed in Pa, and eligible to sign up for COBRA, for $412 a month, just me. However, there is a $173 per month high deductible policy with Blue Cross, on eHealthInsurance.com, that I am tempted to apply for. I'm afraid I will be denied, and wonder what future problems will arise for me due to being denied. I do have some minor(?) pre existing conditions. Three different health insurance agents could not tell me if I would be denied or not, only that it is possible. Bad cholesterol is a bit high. Total chol is a bit high. PCP wants me to go on a statin. I said no. Blood pressure a bit high ( 135 over 90) but PCP said those were good numbers. Weight is OK. PCP found some moles on me and made a note of it, and wrote me a slip to see a dermatologist about it, but said it was not urgent. I never went to see the dermatologist. But the PCP will no doubt tell the ins co about the moles. Frozen shoulder 2 years ago.

Recently a few good people have suggested I stay with COBRA, and avoid the individual insurance route altogether since they may deny a claim I make later, even if they accept me as a premium-payer, and I value their perspective.

Some questions:

How far back can the insurance company look? This may be moot since I'm sure they are allowed to get my medical history since birth !

Will everything I disclose, plus anything the insurance company finds, go on my file with the Medical Information Bureau? With or without my permission?

If I do not grant permission for them to add my data to MIB, will the ins co simply refuse to consider my application?

The info on the MIB website says I should not have a file at the MIB, since I have not applied for individual health insurance within the last 7 years. I know I can request a free copy of my MIB file, but don't want to stir anything up there.

How detrimental to me will it be to have a file at the MIB, with my medical conditions on it? Will that affect my applications with group plans in the future?

If I'm denied by the insurance co, how detrimental will that be?

Will my credit score be affected?

If I apply for Obamacare in 2014 will I have to pay more than someone of my same age and income, who has never been denied insurance? I believe the answer is no, but not sure.

To summarize, how bad is it to get denied by a health insurance company?


Thanks for any input !

 

[grasshopper]

With BCBS they asked for records for ten years. My total cholesterol had only just dipped below 200 history 220-205. hypothyroid, several things sliced off various places including colon, but all non malignant. I was 54 at the time and I had no restrictions on my policy.

 

[Peter]

I wouldn't have thought those 'anomalies' were bad enough to cause denial. However, I do think you'll be hit with a higher premium than the ehealthinsurance online quote. Could be quite a bit higher.

 

[pb4uski]

I faced a similar situation about a year ago. I was leaning towards private insurance over COBRA mainly because I was concerned that if I had a health issue during my COBRA period that I would be unable to get health insurance later. In that event I would have had a three month gap of being uninsured between the end of COBRA and the start of Obamacare.

I suspect that this is less of an issue for you since COBRA will carry you to Obamacare. In fact, I think even if you were to be denied now that since Obamacare is essentially guaranteed issue that it probably wouldn't have an adverse impact on you.

 

[MichaelB]

You should be fine as long as you provide all the info requested when you apply.

The insurance company has no obligation to provide a policy to you, but if they do, they cannot deny coverage later for a preexisting condition as long as you had uninterrupted converge for at least 18 months and less than 63 days of no coverage while changing policies.

Your policy can no longer be cancelled due to preexisting conditions unless you were dishonest or engaged in fraudulent deceit during the application.

Beginning 1/1/14, you cannot be denied coverage for any reason if you meet exchange eligibility requirements and you cannot be charged more than the standard exchange price regardless of your medical conditions.

 

[gerrym51]

Hello all,

I'm 58, male, currently unemployed in Pa, and eligible to sign up for COBRA, for $412 a month, just me. However, there is a $173 per month high deductible policy with Blue Cross, on eHealthInsurance.com, that I am tempted to apply for. I'm afraid I will be denied, and wonder what future problems will arise for me due to being denied. I do have some minor(?) pre existing conditions. Three different health insurance agents could not tell me if I would be denied or not, only that it is possible. Bad cholesterol is a bit high. Total chol is a bit high. PCP wants me to go on a statin. I said no. Blood pressure a bit high ( 135 over 90) but PCP said those were good numbers. Weight is OK. PCP found some moles on me and made a note of it, and wrote me a slip to see a dermatologist about it, but said it was not urgent. I never went to see the dermatologist. But the PCP will no doubt tell the ins co about the moles. Frozen shoulder 2 years ago.

Recently a few good people have suggested I stay with COBRA, and avoid the individual insurance route altogether since they may deny a claim I make later, even if they accept me as a premium-payer, and I value their perspective.

Some questions:

How far back can the insurance company look? This may be moot since I'm sure they are allowed to get my medical history since birth !

Will everything I disclose, plus anything the insurance company finds, go on my file with the Medical Information Bureau? With or without my permission?

If I do not grant permission for them to add my data to MIB, will the ins co simply refuse to consider my application?

The info on the MIB website says I should not have a file at the MIB, since I have not applied for individual health insurance within the last 7 years. I know I can request a free copy of my MIB file, but don't want to stir anything up there.

How detrimental to me will it be to have a file at the MIB, with my medical conditions on it? Will that affect my applications with group plans in the future?

If I'm denied by the insurance co, how detrimental will that be?

Will my credit score be affected?

If I apply for Obamacare in 2014 will I have to pay more than someone of my same age and income, who has never been denied insurance? I believe the answer is no, but not sure.

To summarize, how bad is it to get denied by a health insurance company?


Thanks for any input !

in the past you've said you would be subsidized under Obamacare so the price should not come into it. If you are not subsidized it will probably be more than cobra-based on mass. in which i live

 

[aja8888]

Online einsurance quotes are typically not what you will pay if accepted by an insurance company. Take my word for that after my wife's COBRA ran out and we applied to several insurance companies through that website. In each case, the premium quoted after the application was much higher.

I would jump on that COBRA offer.

 

[mpeirce]

Online einsurance quotes are typically not what you will pay if accepted by an insurance company. Take my word for that after my wife's COBRA ran out and we applied to several insurance companies through that website. In each case, the premium quoted after the application was much higher.

I would jump on that COBRA offer.

Huh, I guess this is a case of YMMV, but we used the online folks and the quote was very close to what we ended up paying for our HDHI.

 

[nun]

I'd take the Cobra to take you into 2014 when Obamacare will prevent you from being denied coverage because of pre-existing conditions.

 

[Mulligan]

Huh, I guess this is a case of YMMV, but we used the online folks and the quote was very close to what we ended up paying for our HDHI.

Mine was actually a dollar less than they quoted. I never figured that out. I had 2 friends that both were accepted at the published rate, BUT I believe all 3 of us did not have any health issues which of course helps get the quoted rate.

 

[aja8888]

Huh, I guess this is a case of YMMV, but we used the online folks and the quote was very close to what we ended up paying for our HDHI.

The final insurance quotes depend on a variety of factors such as age, medical history, pre-existing conditions, etc. Glad you came out good, but we didn't. My wife has high cholesterol and a breathing issue, plus being 63 at the time.

 

[Animorph]

I would guess the quotes higher than online prices were due to pre-existing conditions that raised the price but were not bad enough for a complete rejection. Online prices are of course the lowest you could possibly get.

I don't know of anything bad resulting from going on COBRA and seeing if you can qualify for something cheaper privately.

 

[pixelville]

No harm in applying to the private insurance and see what they offer. As far as I know there should be no impact to Obamacare, future healthcare or credit history.It is unlikely you would get denied. Most likely possibilities are
1. Insurance company puts a rider on your policy, essentially not covering the pre-existing condition ( in my case I had frozen shoulder a few years back and associated complications to the specific shoulder were not covered)
2. They cover everything but at a higher premium


You can also apply to multiple providers, each one does it differently. I had Tinnitus and frozen shoulder from 2-5 years before. One provider had a rider associated with the shoulder only and the other had a rider associated with ear-nose, etc. In both cases premiums started the same as a ehealthinsurance. But rose very rapidly.
Depending on the deductible in your cobra policy, you might want to decide if the addtl $240 per month for 10 months is worth it.

 

[obgyn65]

I agree with this approach.

I'd take the Cobra to take you into 2014 when Obamacare will prevent you from being denied coverage because of pre-existing conditions.

 

[John Galt III]

Thanks for the informative replies. At this point I'm thinking of applying for the $173 per mo HDHP policy. If I get denied, or quoted a much higher price, or restricted too much, at least it will make it that much less painful to pay the full price of $420 per mo for the COBRA, knowing that the $173 per mo option is not available.

However, I'm still a bit leery of having a claim denied for a pre-existing condition, even if I am accepted. I was talking to an insurance agent at ehealthinsurance.com a few days ago, and he said it happens a lot still.
I'm referring to pre-existing conditions that were not discussed in the application, not known to patient or doctor, but were deemed to be pre-existing by the ins co at the time of the claim.

 

[Mulligan]

Thanks for the informative replies. At this point I'm thinking of applying for the $173 per mo HDHP policy. If I get denied, or quoted a much higher price, or restricted too much, at least it will make it that much less painful to pay the full price of $420 per mo for the COBRA, knowing that the $173 per mo option is not available.

However, I'm still a bit leery of having a claim denied for a pre-existing condition, even if I am accepted. I was talking to an insurance agent at ehealthinsurance.com a few days ago, and he said it happens a lot still.
I'm referring to pre-existing conditions that were not discussed in the application, not known to patient or doctor, but were deemed to be pre-existing by the ins co at the time of the claim.

Will this policy still be in effect after exchanges open? How high is the deductible? Personally, that rescission factor, always made me nervous as I don't trust them further than I can throw them. But, at my age of 45 when I first signed up for the individual plan, and knowing I was in great condition, the financial reward greatly exceeded the risk. I don't know your financial situation, but at 58, only 7 years from Medicare, I don't know if I would risk joining and staying on an individual plan. I have read that nasty rescission feature generally only goes back 2 years from acceptance in most states. But still it would be very discomforting dealing with this specter when knowing for a few more bucks they would cover your condition with little harassment, if one was to unfortunately occur.

 

[John Galt III]

Will this policy still be in effect after exchanges open? How high is the deductible? Personally, that rescission factor, always made me nervous as I don't trust them further than I can throw them. But, at my age of 45 when I first signed up for the individual plan, and knowing I was in great condition, the financial reward greatly exceeded the risk. I don't know your financial situation, but at 58, only 7 years from Medicare, I don't know if I would risk joining and staying on an individual plan. I have read that nasty rescission feature generally only goes back 2 years from acceptance in most states. But still it would be very discomforting dealing with this specter when knowing for a few more bucks they would cover your condition with little harassment, if one was to unfortunately occur.

Yes, I think the policy will still be in effect when the exchanges open. It's a $5,000 deductible.

I too am concerned about rescission if I reject COBRA, and get the individual HDHP policy.

I'm also having a hard time accepting the fact that I can afford to pay the $420 per month even though I don't have to. It really rubs my frugality streak the wrong way. But I'd only have to pay it until I get a job with benefits, or 1/1/2014, which is good.

 

[aja8888]

I'm also having a hard time accepting the fact that I can afford to pay the $420 per month even though I don't have to. It really rubs my frugality streak the wrong way. But I'd only have to pay it until I get a job with benefits, or 1/1/2014, which is good.

Well, you could always self insure until the new job comes through.

 

[Animorph]

Yes, I think the policy will still be in effect when the exchanges open. It's a $5,000 deductible.

I too am concerned about rescission if I reject COBRA, and get the individual HDHP policy.

I'm also having a hard time accepting the fact that I can afford to pay the $420 per month even though I don't have to. It really rubs my frugality streak the wrong way. But I'd only have to pay it until I get a job with benefits, or 1/1/2014, which is good.

If you went with the cheap option you would only be stuck with it until ACA kicks in. So there's only a short period where recission would be a problem, I think.

 

[ziggy29]

If you went with the cheap option you would only be stuck with it until ACA kicks in. So there's only a short period where recission would be a problem, I think.

I think so. The good news is that this should (assuming no changes in the law) only be a concern until 1/1/2014.