Health Insurance Denied or Revoked

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Archived Q&A and Reviews

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Cal Cobra ended, I have no insurance

Feb 2012

After 18 months of Cal Cobra I find myself with no insurance. I am a cancer survivor almost 13 years out (hurray!) but last year because of medications I was on I was considered uninsurable and turned down for life insurance. Can anyone recommend a broker or consultant to help me find insurance? What is the deal with pre-existing conditions? Has that kicked in yet? Any help would be so appreciated. Thanks BPN.

Yes, I have something for you! PCIP - Pre-existing Condition Insurance Plan, sponsored by the State. To apply for this plan, you must have been turned down by another plan...I was never so thrilled to been denied coverage: this plan is far better than the crap plan I'd been paying big bucks for (essentially, catastrophic insurance, as the deductible was $5K - over $500/mo for that because I'm in my 50's).

Call Lynne Caffrey, who is an excellent insurance broker - you'll be happy you did. She and her son work together. They provide excellent service and whatever solutions exist (don't get me started, grrrr!): Lynne Caffrey 510-444-5447 http://www.caffreyinsurance.com/ Jessica

If you are able to wait 6 months from when your insurance ended your best bet will be to enroll in the California Preexisting Condition Insurance Pool (PCIP). This is an interim program that will be available until 2014 when the pre-existing condition exclusions are no longer permitted (provided of course that the Supreme Court doesn't over turn the law and we don't end up with a Republican in the White House.) There is also the California Major Risk Medical Insurance Program (MRMIP), which is available without a wait, but has higher premiums and lower benefits - a quirk of the federal law. You can find information about both programs on the California Managed Risk Medical Insurance Board (CA MRMIB) web site. sandra

You have many more options thanks to Obama health care reform. Check out http://healthcare.ca.gov/HealthCareYou.aspx , especially the Pre- existing Condition Insurance Pan (PCIP). Thank you Obama

There is a special program for Californians with pre-existing conditions. Here's the link: www.pcip.ca.gov/Home/default.aspx I don't know how much it costs, but it could be a good resource. healthcare for all

My 60-y-o mother has been denied private health insurance

Feb 2007

My 60 year old mother recently sold her house and left her job on the east coast and now lives with us and is our nanny. We naively thought that she could just buy health coverage when she is no longer eligible for COBRA (next August)until she qualifies for Medicare at 65. She applied for an individual plan through Blue Cross and was flat out denied. She spoke to an insurance agent who said she was uninsurable because of the amount of medication she takes. He said she may be able to get an expensive ($1000/mo +) policy that would cover catastrophic illness or injury but not regular doctor's visits or meds. Her meds are for bi-polar and an underactive thyroid. Is it true that she will never get good coverage? She is very stable but we are considering asking a phsyciatrist to say she is disabled by her bi-polar so she will qualify for medicare. I don't see any other options but I really don't know much about how our broken healthcare system works. Thanks. Elizabeth

It's hard to find insurance. Hopefully, she is still on COBRA. If so she should be insurable under HIPPA, a law enacted by Clinton to ensure people with existing conditions are insured. Blue Cross and Blue Shield offer HIPPA policies. Of course they are very expensive, but they cover more than catastrophic care. There are specific rules you must follow to qualify for these plans. When I did it, you had to pay and use COBRA fro the duration of the term and then you get one of these plans. You could not be uninsured for more than a few weeks ( I don't remember what it was since I wasn't ging a day without insurance.) A good insurance agent should know all of this to help you through it. The agent I used I won't recommend. Good luck. linda

Insurance won't accept infant with sickle cell trait

Jan 2007

My friend's newborn has the sickle cell trait but only from one parent so it will not develop, she only will carry the gene. I am wondering if anyone can offer advice as to what insurance will provide for her because their current insurance (blue cross, I believe) won't take the baby. Please share any information on why the insurance refuses to provide for this child or any similar experiences with sickle cell. Thank you
A concerned friend

I have sickle cell trait and one of my two bi-racial children has it also. I don't understand why an insurance company would deny coverage for your child just because they carry a genetic trait that usually does not affect their health in any way? I would question this policy and see if that is even legal! Good luck. tora

All three of my children have sickle cell trait and we have never been denied insurance. I would go to an insurance broker -- they know what they are doing. I know one who is very good and helped a family that had been denied insurance to obtain a good policy at a good price. I am sure there are others as well. Her name is Kay Smith and her number is 650- 345-8105 anon

Denied private insurance - what are our options?

May 2004

Our family of five is currently on COBRA with a monthly premium of almost $1400. We have been denied private insurance through blue cross and blue shield for having very minor chronic problems. Someone suggested that I look into health plans offered through trade or industry associations. I also read on the internet about the scams that are operating as insurance. 1) does anyone have any knowledge of whether this is really a viable option to pursue. does CA regulate these entities? 2) can anyone recommend an association which has good coverage. Between my husband and I we have enough degrees and job experience that we may actually qualify to join one of these. Thank you in advance for your help. This is pretty scary.

I work in the HMO industry and believe that association health plans are a good alterantive depending on your situation. Unfortunately, I am not that familiar with individual plans to give you specific information on good ones and not so good ones. However, I can point you to some tried and true ''industry'' links. You can't go wrong with these trusted resources for background info on any health care question you have:

The Department of Managed Care - CA has strong guidelines about the collection of information and health insurance consumer resources (not just HMOs) CA has more publicly available informatin than any other state: http://www.hmohelp.ca.gov/

General info on getting smart about health care (note: the Kaiser foundation is NOT affiliated with Kaiser health plan they share the name only): http://www.chcf.org/ http://www.kff.org/

Good luck - I know it's tough Lily

IEEE has an excellent life insurance program: I know they offer a health insurance product. It's worth looking into.

Can't get insurance for daughter with health issues

July 2002

When my partner was recently laid off, our family went on COBRA health insurance. Because of the high cost of COBRA, I tried to switch my whole family to Blue Shield, but they wouldn't accept my daughter because she has had some health issues. COBRA will run out eventually, and I'm very worried about my options for insuring her. Can anyone provide any advice or suggestions about how to insure a child who has health issues? Thanks. Anonymous, please.

There are a couple of things that may be useful, depending on your daughter and your family's situation, medical and financial.

If your daughter is disabled, she may be eligible for Medi-Cal. She can also continue past the COBRA expiration for coverage for the disabling condition only. You will need medical verification of disability.

If she is not disabled, she may be eligible for Healthy Families, but you have to have a relatively low family income. (You said ''partner'' and not ''spouse'' -- I'm not sure if ''family income'' would need to include a technically unrelated adult). Info can be found at http://www.healthyfamilies.ca.gov/. There is also something called the Major RiskMedical Insurance Program, which provides insurance for people with pre-existing conditions. I do not think it is at all low cost. Info at http://www.mrmib.ca.gov/MRMIB/MRMIP.html. That all said, you may want to apply for a Kaiser individual plan. A few years ago, when I was shopping for insurance, I was turned down by both Blue Cross and Blue Shield due to my medical history, but Kaiser accepted me. Good luck. M.S.

We were on COBRA when my son was born with a chronic medical condition. We continued on COBRA and when it ran out, we signed my son up on a ''Guaranteed Issue'' plan--basically it's high deductible insurance that you qualify for once COBRA runs out if you can't get other insurance. It's not cheap--for my son alone it's about $160 per month, but considering the bills we have it's worth it! You didn't mention your child's medical condition, but if it is genetic in nature there is also a state- funded insurance plan you can sign up for. There may be other state-subsidized plans available that I'm not aware of.

FYI--when we were struggling with insurance options we found Bill Killips an invaluable resource. He is an insurance agent a friend referred us to. For a few weeks while we were considering our options he consulted with us and gave us the benefit of his knowledge of the industry, including the complicated COBRA regulations. He is one of the cheeriest and most positive people I've ever known, and is very prompt in returning phone calls. We always felt like we were a priority, and we weren't even his clients (yet!). Of course once we determined what was best for us we wanted to work with him and he continues to provide us with excellent service. We think the world of him. His phone number is: 925-906-4618 (Walnut Creek). Christina G

I had a very similar experience -- left my job, COBRA was too expensive, so I applied to Blue Shield thinking all was OK. Blue Shield accepted everyone except my youngest son. I eventually applied to HealthNet and they accepted him -- perhaps they are more liberal than BS. -- good luck! anon

The issue of COBRA, HIPAA, etc is most confusing. Here's a consumer guide that will hopefully help you sort things out: http://www.healthinsuranceinfo.net/ca00.html. Laura

Denied insurance because of hay fever and cholesterol - what now?

July 2002

A month or so back I asked the list for recommendations about self-payed health insurance for our family -- my husband was recently laid off and he and I are now both self-employed. The consensus of the list seemed to be that Blue Shield was the best bet, and we liked the terms of their plan a lot. But while my son and I have been accepted, they have denied coverage to my husband because -- get this -- he has hay fever and high cholesterol and admitted to seeing a chiropractor now and then. So now what do we do? He's really panicked -- losing his job was bad enough, but now to feel like he can't get health care is really scary. Kaiser is an option, although we're a little worried he may get denied there too, and he really likes his non- Kaiser primary care doc.

So here are my questions: what do you do if you're denied coverage? Are there other health plans that may be more receptive than Blue Shield was of a perfectly healthy 42 year old man who gets sneezy in the springtime? Should we have omitted more information on the application? Is there any way of appealing a denial? Any advice/recommendations would be much appreciated. Nelly

We have a fabulous health insurance 'broker' whom we have worked with for over 10 years. My husband and I are both self employed so health insurance can be a real headache. He does all the footwork and explains the nitty gritty of each policy to me. Insurance companies make changes constantly so I find myself reviewing our policy every year. He will help you work with any pre existing conditions you have and take the nightmare out of applying for insurance and filing claims. I cannot recommend him highly enough. He has become like a friend and I have recommended him to others who feel he has really saved their sanity around health insurance. And we have never met face to face. His name is Tony Uccelli and he is in Belmont. His number is 650-592-3355. Email tuccelli at prodigy.net. He is a gem. lark

I am self-employed, and while my husband is covered by UC and my kids by Healthy Family, I pay for Kaiser for myself. I've been very happy with it. It's reasonable, there's a modest co-pay, and I can go see whatever specialist I need to, all under one roof. Your husband should look into Kaiser for himself. I wouldn't mention his allergies, though. That's the way the game has to be played these days. Julie T.

I was in a very similar situation a few months ago. My husband and son were approved by Blue Shield, but I was rejected because of an expensive medicine I used to take for migraines. I was shocked because I always considered myself to be a very healthy person. I was also rejected by Nationwide. Eventually I was accepted by Blue Cross for a limited PPO plan. They charge me a 20% premium for the coverage, but at least I have insurance. Perhaps they would be willing to cover your husband, too. Kathryn

This same thing happened to me, and I was upset, angry, and anxious. We do now have Blue Shield and I like them pretty well, but it was ridiculous getting past their restrictions. Here's what we did:

1. We used an insurance broker named Forrest Lupo. I don't have his phone number, because it's in my husband's work phone book, but if you want to contact me personally, I'll get it for you. He really went to bat for us in a most gracious way, and walked us through processes that contested the insurance denial.

2. Following Forrest Lupo's instructions, we had my doctor write a letter to Blue Shield saying that I was in good health and that the issues mentioned (a knee injury for which I was no longer receiving any treatment whatsoever) posed no foreseeable problems.

Insurance companies are so avaricious that working with them is really like making a deal with the devil, but we have insurance with Blue Shield now and it really is better than the alternatives we otherwise considered. elza