Extending Temporary Health Insurance Coverage

[dklittl]

What is the name of your state? GA

I understand the difficulty of this situation, but any assistance would be helpful.

My girlfriend after graduating from school in 2005, got a temporary insurance policy in May of 2005 with Golden Rule in Georgia. She wound up being admitted within a month of the policy for something called Acute Transverse Myelitis, an early stage of MS. In March of this year she was again admitted into the hospital and received an official diagnosis of MS. Her policy had expired but because she was admitted into the hospital for the same illness they covered her under an extension policy.

Now unfortunately because of the effects of MS she can't work right now, and its almost impossible to get catastrophic coverage in the State of GA. I'm a lawyer who doesn't practice, but I am writing her former policyholder a demand/ask letter to extend some kind of coverage in the future. I'm not versed in insurance law at all, but I'm hoping that someone could give me some advice on any direction that I might want to go in. I'd hope that I might have some legal standing for her request, but if not any issues that I might be able to bring up that could be convincing to the insurance company in this case would help.

Thank you in advance for your thoughtful reply.

[moburkes]

Originally Posted by dklittl

What is the name of your state? GA

I understand the difficulty of this situation, but any assistance would be helpful.

My girlfriend after graduating from school in 2005, got a temporary insurance policy in May of 2005 with Golden Rule in Georgia. She wound up being admitted within a month of the policy for something called Acute Transverse Myelitis, an early stage of MS. In March of this year she was again admitted into the hospital and received an official diagnosis of MS. Her policy had expired but because she was admitted into the hospital for the same illness they covered her under an extension policy.

Now unfortunately because of the effects of MS she can't work right now, and its almost impossible to get catastrophic coverage in the State of GA. I'm a lawyer who doesn't practice, but I am writing her former policyholder a demand/ask letter to extend some kind of coverage in the future. I'm not versed in insurance law at all, but I'm hoping that someone could give me some advice on any direction that I might want to go in. I'd hope that I might have some legal standing for her request, but if not any issues that I might be able to bring up that could be convincing to the insurance company in this case would help.

Thank you in advance for your thoughtful reply.

She may be eligible for medicaid. The insurance company is not required to extend coverage.

[mlane58]

Inquire whether about portability and waiver of premium with the insurance company. Is she considered totally disabled? If she is, the carrier might very well consider the portability and waiver of premium as long as not too much time has passed.

[Betty]

You may want to see if she qualifies for Medicaid or a state based health care assistance program. They were developed to help provide their residents with access to medical care.
The ins. co. does not have to extend the coverage for any additional time.

[somarco]

The policy is temporary with a finite timetable for benefits. Once the policy expires the carrier is under no obligation to renew or extend benefits. Under her current condition she is ineligible for individual health insurance coverage. GA does not have a risk pool but she may inquire with the DOI if she is HIPAA eligible. If so, she will be assigned a carrier for a limited benefit plan and a high premium.