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Maggym | Can a health insurance turn you down for coverage if you have had continue medical coverage? ? |
My daughter and her husband recently moved back to California where her husband accepted a good paying job but it does not have medical coverage, therefore they have to purchase one. Her husband previous job had medical coverage and they were cover until they moved to California. Kaiser deny coverage saying that due to preexistence condition they cannot get coverage through them. Isn't there a law that prevent this or am I mistaken?
If you know the answer, please let me know how you got your answer.
Right now they are applying for cobra coverage until they find an insurance that will cover them.
thank you to anyone whose is able to answer this question. |
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Zarnev
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Yes, they can be denied coverage with a regular individual plan; there is no law. However, he would eventually qualify for a HIPAA plan and there is a law stating he must be accepted. Almost all insurance companies have a HIPAA qualified plan although the plan choices are limited. The law guarantees coverage but does not guarantee the premium. A premium of nearly $2000 per month is not unheard of. To qualify he must exhaust COBRA and get accepted on the HIPAA plan within 63 days of COBRA termination.
He may not be eligible for COBRA since he moved to a different state. If the plan he had is not available in CA it won't do him any good. If he does get coverage with COBRA his wife does not have to be on with him. It'll most likely be cheaper for her to get on a plan by herself.
Did you apply with Kaiser through an agent or are you acting as your own agent? Visit a local agent that works with all the major companies. The agent can do a "prescreen" with each insurance company to see if they'll accept him and on what terms. There is no extra charge using an agent.
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Soozie Q
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I know what you're thinking of and sorry, its not the same thing. Group insurances have to take people, but individual plans can and absolutely will deny coverage to anyone they want to. Is that fair? No. Is it legal? You bet.
What you're thinking of is (in my state anyway), you can't be denied treatment for a pre-existing condition if you've had insurance and there hasn't been a lapse in coverage. For example, a couple years ago I had a lump removed from my underarm. A very small bump appeared there when I was a teenager but it never bothered me. It had never grown nor was it sore. But when I was 30, all of a sudden, this tiny bump I had practically forgotten about starting growing and becoming very painful. I saw a surgeon who wanted to remove it and got pre-authorization from my insurance company.
Well when the bill came to my house that I owed $16,000, you can imagine my shock. My insurance company denied payment because they found in my medical records that I first noticed it several years before. However, a very close friend of mine let me in on the secret that my insurance could not deny me coverage for a pre-existing condition if I had had continuous coverage of insurance for the past so many years. (I can't remember now, but its not that many). I said I could prove I had insurance everyday of my life! My insurance quickly dropped it after I found out about that and asked them about it. They paid their part of the bill and I paid mine. |
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sarah314
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You can be denied coverage on an individual policy.
There are HIPAA policies out there that have to take all people who have had continuous insurance, but those are typically expensive. (Higher premiums to cover the fact that the people who have those policies are more likely to have higher medical expenses.) A person would generally only enroll on one of those as a "last resort."
Depending on what the pre-existing condition is, they may have a hard time finding an individual insurance policy. (Either they won't get accepted at all, or if they do, they'll have to pay a high premium.)
Unfortunately, this is something that they should have considered before he accepted the new job. Sometimes a raise in salary isn't really a raise, if you lose your benefits and have to start paying the full cost yourself. You may find that you actually end up with less money in your pocket every month, because you have to pay the full cost of your medical coverage. |
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HealthQuote360.com
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You are not mistaken.
There is a law that protects people in situations similar to you. (Although, you must first exhaust all other health insurance options available to you - including COBRA coverage).
Here is some more information on the HIPAA health insurance laws: |
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Irish
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Yes, they can turn you down. They had a group policy before where everyone gets included, but now he's applying for an individual policy and the insurance company wants to know on any previous conditions. Being turned down for a pre-existing condition is quite common. Some will take him for a regular policy but will exclude the pre-existing condition. Tough spot to be in. |
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mbrcatz
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You are mistaken.
A very few states, New Jersey comes to mind, require that an insurance company insure ANYONE, without excluding the pre-existing conditions. BUT, they still UNDERWRITE the policy, so depending on what's wrong, they could CHARGE you whatever they want - $3,000 a month, or whatever.
But California, to the best of my knowledge, is NOT a guaranteed issue state. So, for a PRIVATE policy, an insurance company is NOT required to take you.
You might be confusing this with GROUP insurance, that you get through an employer. They ARE required to take all members of the group, and if there was prior coverage, they cannot exclude preexisting conditions.
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Richard
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I have been disabled for five years with Medicare and humana since. Just recently humana has refused coverage from my eye surgeon who I had from the beginning and only see about twice a year for checkups. Reason, too high, can they do this legally? I was contacted by the surgeon not humana.
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