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wowee | Are there any appeals/grievance processes against health insurance companies who deny policies? |
This just takes the cake! My son is 4 months old. When he was born, the doctor heard a slight murmer in his heart. It was checked out with an Echo and we also followed up at 2 months with a cardiologist who confirmed that he has an innocent murmer. It is just basically little strings (like the inside of a pumpkin) that causes noise when the blood goes across it. The cardiologist went on to explain that somewhere around 85% of all people have this condition. It requires NO further treatment. However, because the Echo was performed, evidently he has been denied health insurance which is bull$hit if you ask me. I just want to know if there are any other people out there who have gone through the same thing or if anyone knows what I can do? He's 4 months old! He has to have health insurance!
Additional Details
We will not qualify for CHIPS. |
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sarah314
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Unfortunately, your son will have a tough time getting coverage from any private insurance company right now. Newborns are somewhat of a financial risk for a private insurer to take on, because so many unexpected things can pop up in the first year of life. Since your son has already consulted with a cardiologist, he'll have a problem getting on a private policy.
Your state's Department of Insurance regulates insurers, and you can certainly follow-up with them if you'd like. But I will caution you that they aren't going to be able to do anything about it. No insurance company "has" to sell you a policy for someone who doesn't meet their medical underwriting criteria.
If you won't qualify for CHIPS, you'll have to get him on a policy through your own or his father's employer. Group insurance policies through employers have different rules, and they will have to take him.
P.S. Were you uninsured at the time of his birth? The best option to get coverage for a newborn is to add them to the parent's policy within 30 days of the birth. If you already had family coverage or coverage through an employer, they would have had to accept him also. Its difficult to purchase private coverage for a newborn...I'm sorry someone didn't caution you about this before he was born.
Edit to add: Or before you decided to leave your job, which would mean loss of group coverage. Its a little late in the game to be looking for coverage beginning January 1st. Unfortunately, it should have been lined up before leaving your job. Is COBRA an option? I know its expensive, but that might be his only option at this point if you don't qualify for state CHIPS or Medicaid. |
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Zarnev
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There is no appeals process other than talking with the company to see if you can convince them to accept him. All insurance companies have underwriting guidelines and the guidelines are different with each company. Visit a local agent that works with all the major companies in your area. The agent can work with you and talk with the underwriters to see if any of them may accept your son before you waste the time applying. However, it can take several weeks to get a policy issued so even if you can find a company that will accept him by the time they get the medical records you probably won't get a Jan 1 effective date.
You may have to get COBRA for your son so he'll be covered. Insurance companies are wary of newborns with any type of problem. After he's been covered by COBRA for awhile with no problems they may reconsider him. |
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mbrcatz
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No, there is none. You can always complain to your state insurance commissioner, but the truth is, unless you live in a "guaranteed issue" state, where they HAVE to issue you a policy, they flat out don't have to issue you a policy. They don't even HAVE to tell you why.
I will tell you, though, that it's really, really hard to find a private policy on ANY child under a year old - there are so many checkups and immunizations, that it's actually MORE expensive than any time in the next 18 years, that first year.
I think you're going to have to buy the COBRA coverage for the next 18 months. And then likely ONE of you is going to have to get a job, just for the sake of the insurance benefits. |
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KG Mom
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You can appeal (and I am assuming we are talking about indivdual coverage), but you probably won't get anywhere.
Your choices are....CHIPS (if you qualify) or your state's high risk pool.
Sorry I wasn't more help! |
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ANN R
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By google to collect some related information or you may try using answer engines like yahoo answer or yedda.com to get some related ideas.nonetheless,If you prefer some direct resource,here http://www.HealthInsuranceIdeas.info/free-online-health-insurance.htm is a good one from my own experience. |
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Insurance Pickle.com
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He should have automatically been covered by yours if you were properly covered. Did you have health insurance? |
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