Denial of coverage for past medical history

[violenttuesday]

As a child I had leukemia. I had my last bone marrow when I was 6,
then once a year check-ups for 5 years to see if the
cancer would come back. I am now 25 (next month) and
have never once had it re-surface since the initial
chemo. I was told by doctor's that I have as much of
a chance getting it again as anyone else would a first
time.

I have been told that I can get medical coverage,
however only through a group plan. I have been told
that if I were to apply for coverage as an individual
I would be denied due to medical history. I have
never had to test this theory, until now. I have
always been under group plans and have had no problem
getting coverage. When I left my previous employer I
did not opt for Cobra, as my new position said that I
would have coverage. This was in February. It's now
May and the company I'm with has not been able to
obtain coverage since they're a "start up" and don't
have enough evidence stating the company is
legitimate. I called Blue Cross & Blue Shield to
inquire about individual coverage. They told me point
blank on the phone that "It is in our underwriting
guidelines that anyone that has or has had leukemia
regardless of current state is instantly denied."
They would not provide me the info, only verbally.
They said they do not make the laws, the HIPPA does.

I do not see how someone 20 years in remission cannot
be approved; especially being that I've always had
coverage, even though through a group.

Is this actually true? Is there anything I can do? I
might be able to get my hands on that "underwriting
book", however even if I do can they legally turn me
down?

Any and all help would be apperciated. I live in California

 

[ALawyer]

This is a matter to ask the California State Insurance Department.

Insurers are entities that try to make a profit, and they do that by pricing for the risks they cover, or denying to cover risks that they conside too great. On life insurance, for example, a dollar of coverage costs more if you are 70 than if you are 25. A house on the San Addreas fault is more3 expensive to insure than one far from an earthquake zone. A driver with a spotless record is given a far better rate than a guy with 2 DUIs, assuming she can even get insurance.

I would consult a good broker and see if there is anthing she can do for you.

 

[violenttuesday]

This is a matter to ask the California State Insurance Department.

Insurers are entities that try to make a profit, and they do that by pricing for the risks they cover, or denying to cover risks that they conside too great. On life insurance, for example, a dollar of coverage costs more if you are 70 than if you are 25. A house on the San Addreas fault is more3 expensive to insure than one far from an earthquake zone. A driver with a spotless record is given a far better rate than a guy with 2 DUIs, assuming she can even get insurance.

I would consult a good broker and see if there is anthing she can do for you.

I do appreciate your response and will speak with the California State Insurance Department.

My whole point however was that I'm NOT considered a risk anymore. I could understand it if I was undergoing chemo still, or say still within a 5 year timeline of remission. I see what you are trying to explain with your examples however they are not fair comparisons considering all medical documentation (Johns Hopkins Hospital, St. Jude Hospital, etc.) which prove that I have just as much of a chance getting the leukemia back as you do a first time. So for them to deny me is like them denying you when you are in good health.

 

[ALawyer]

Unfortunately, MOST insurers often have underwriting guidelines that are not as up to date as they should be, and medicine is still somewhat partially an art as well as a science.

I personally do not know if there are any added risk factors of recurrrence after so many years for your particular form of leukemia. But assuming you are correct, that may not be conlusive for the mumbo jumbo that is insurance underwriting.

Have the doctors also conducted a scientific a study that would conclusively demonstrate that a person who had recovered from your form of leukemia no more likely to face not only a recurrence of the same type of leukemia, but also all other health related problems than people with no previous record of illness?

One more thing. You probably are not the first person to have had this problem with insurance. Ask the Leukemia Society for . And subject forwhat the added riswhat doctors say I really DO understand guidance. They may be even MORE helpful than the CA Insurance Department. Also, contact your state assembly person, as if there is no law now dealing with health underwriting, perhaps there might be in the future.

 

[bowler87]

#! NEVER rely on a voice on the phone that comes from Blue Cross.

I think they are paid a bonus to handle as many calls as they can in a day, without regard to accuracy...

#2 You are a risk because you will seek medical treatment(TESTS) on a regular basis. If you have the disease or not, you still have follow-up care.

#3 California Department of Insurance has no authority over the conduct of Blue Cross of California.
Begin a letter writing campaign and write Blue Cross at Box 4386 Woodland Hills CA 91465
Call the governor's office and ask who regulates Blue Cross
It may be the Department of Corporations.

 

[violenttuesday]

#! NEVER rely on a voice on the phone that comes from Blue Cross.

I think they are paid a bonus to handle as many calls as they can in a day, without regard to accuracy...

#2 You are a risk because you will seek medical treatment(TESTS) on a regular basis. If you have the disease or not, you still have follow-up care.

#3 California Department of Insurance has no authority over the conduct of Blue Cross of California.
Begin a letter writing campaign and write Blue Cross at Box 4386 Woodland Hills CA 91465
Call the governor's office and ask who regulates Blue Cross
It may be the Department of Corporations.

Actually I do not have follow up care; you only have follow up care the first 5 years of remission, after that you're on your own unless of course something obvious comes up---I haven't had any follow up check-ups in 14 years-only normal visists to the doctor like every other healthy human being...

I will try to write-thanks for the info-

 

[CIAA]

Violenttuesday, try several brokers and companies, it sounds as if you should be able to get coverage without to much trouble at all. Some applications ask only about tratment and diagnosis within 3-5 years. Even if your leukemia is required to be disclosed, if you will accept a waiver for this condition, you should be able to get coverage.

Insurers are required to use credible and published underwriting guidlines in order to prevent discrimination. If you submit an application and then you are declined you can be entitled to see and examine the underwriting guidlines and even challenge their credibility. However, I really don't think it will come to that based on the medical history as stated. GOOD LUCK !

 

[violenttuesday]

Violenttuesday, try several brokers and companies, it sounds as if you should be able to get coverage without to much trouble at all. Some applications ask only about tratment and diagnosis within 3-5 years. Even if your leukemia is required to be disclosed, if you will accept a waiver for this condition, you should be able to get coverage.

Insurers are required to use credible and published underwriting guidlines in order to prevent discrimination. If you submit an application and then you are declined you can be entitled to see and examine the underwriting guidlines and even challenge their credibility. However, I really don't think it will come to that based on the medical history as stated. GOOD LUCK !

I have been looking into brokers-as far as "normal, good coverage" instead of "high-risk" insurance it's unfortunately not so easy. I've tried Blue Cross & Blue Shield, and the woman on the phone with Blue Cross was even nice enough to read me the underwriting guidelines & tell me not to waste my time applying. The underwriting guidelines state that anyone that has had leukemia in their lifetime regardless of how long ago is instantly rejected. She said if I do apply and they turn me down it will make it that much more difficult to get insurance, because the rejection is like a red flag to other companies that might normally let me have insurance (companies that only have you disclose 3-5 years like you stated). I'm trying to find one of those group plans that take a lot of people-all different individuals that can't get covered through a company-and cover them under one group as if it's their own company-probably another form of brokerage.

 

[southernponyboy]

In Texas, if you are denied medical insurance you will qualify for what is called a 'state pool' but I am sure that they will exclude anything to do with the leukemia if anything were ever to surface again. Also the price is extremely high.

I dont really know where for you to try.

Sorry I'm not much help.

Good Luck

 

[nan77113]

Check to see if you are still eligible to obtain COBRA. You normally have 90 days from the date of termination of your previous group policy to elect COBRA. If it has not been 90 days, tell your former employer you want it. You must pay past premiums from the date of termination. COBRA premiums must be paid to your former employer (but on occasion are paid to the insurer). Missing the deadline for payment to your former employer will result in your immediate removal from their plan, so make timely payments.

If it has been more than 90 days since your termination, call the COBRA hotline. They will almost always listen to the consumer over the company. Possibly you could obtain it even if you are past the 90 days.

Read the latest HIPPA guidelines. They were designed to assist consumers (albeit they are difficult to interpret). One of the HIPPA regulations relates to "pre-existing condition limitations". These guidelines affect group insurance.

Another alternative is to seek employment where you can obtain group health insurance. The larger the company, the better are your chances that their will be no "pre-ex". Even group policies can "pre-ex" if there has been a lapse of more than 63 days in coverage between group insurances. So it is possible, that even if you obtain group coverage, your condition may have "pre-ex" for some limited amount of time. Usually 3 months treatment free or 12 months.

Hope this is helpful. Good luck!

 

[cbg]

It's 60 days from termination on COBRA, not 90. In the initial post it says that he left his job in February, so it's highly unlikely that COBRA will be an option.

 

[nan77113]

It's 60 days from termination on COBRA, not 90. In the initial post it says that he left his job in February, so it's highly unlikely that COBRA will be an option.

You are correct, my error. It is 90 days for payment of premium, I believe. I still believe it is worth pursuing.

Depending upon the date the individual left employment, insurance is sometimes covered for a full month beyond termination. Also, companies frequently do not edit their billing statements for terms, thus the insurance company will not go back and retroactively terminate premium due resulting in the individual having insurance beyond the point of termination.

It is a long shot at best.

 

[cbg]

60 days for signing up; 45 days from the day that you sign up to get the premium in, regardless of whether you sign up on day 1 or day 60. So it's a maximum of 105 days from termination.

Yes, I grant you that sometimes the bills are not edited immediately. However, I have it direct from the DOL that even if the company pays the first month or two deliberately or accidently it does not change the COBRA dates. When my company did layoffs we paid the first two months as part of the severance package and I inquired.

The poster can certainly give this a try but you're right, it's VERY much a long shot.

 

[CIAA]

Well, I believe that it may be 60 days from the date of notice. If the empoloyer fails to properly offer COBRA as required I believe that it can be argued that the employer did not comply and that the time of election has therefore been extended.

In regard to the Texas High Risk Pool, I believe that they do not exclude pre-existing conditions, or at the maximum only exclude to the extent allowed by HIPPA.

 

[Jeter]

Unfortunately, no matter how long you have been in remission, you will always be considered high risk. Remission means that you still have the disease and it could rear its ugly head at any time. Health insurance deals in mortality tables and percentages. The idea is for the insurance company to pay out as little as possible while taking your money. There's no way an insurance company is going to take you on with the risk that you could relapse the day after coverage starts and cost them a fortune in medical bills. It's a sad fact that money takes precedence over life...

Jeter