Application Declined - Need Help
It did state minimal plaque. I am 55 years old - should have some. I thought that was good - all I needed to do was reduce my blood pressure. I lost 15 pounds and watch diet my last three visits with this doctor 11/05, 1/05 and 2/8/06 blood pressure was normal 120/80 range. Present blood pressure normal. I am on cobra now - but need health insurance. If you look at my records - it may appear I have a lot of problems. But the test came back fine. I plan to change doctor. I think this doctor wanted to run tests to increase revenue in his office. How far back do insurance companies look at your medical records? I plan to go to a different doctor. Any suggestions on what I can do to fix this problem. I do believe Iam healthy.
If you are successful in your appeal, or unable to secure coverage with another insurance company, there may be options available to you under federal HIPAA regulations. All states have guaranteed issue options available to persons that are exhausting their COBRA coverage and are unable to secure individual health insurance. We can help you understand the options in your state, if you reply to this commentary with the state in which you reside. Also, when does your COBRA terminate? The look-back limits regarding pre-existing medical conditions also vary from one state to the other. 7 CommentsLeave a comment |
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I was declined major medical insurance. The reasons listed came from my Doctors records. The records indicated history of hypertension, carotid bruit, aortic valve murmur and arthrosclerosis. I was shocked. ( I got a copy of my medical records) I am 55 years old and do not take any meds. However, back in 2005 - due to a stressful job, aging parents and major hurricane. My blood pressure was high. The doctor recommended meds the first time I went to him. I decided not to take the meds but lose weight and change diet. In reviewing my records he noted diagnoses hypertension, carotid bruit, aortic valve murmur and arthrosclerosis - before any actual tests were performed. This was our first visit. He wanted me to get ultrasound of my carotid and echocardiogram. I did and both came both normal. “normal transthoracic echocardiogram read by heart doctor and the ultrasound for the carotid bruit was negative within normal limits in both systolic and diastolic readings
You have a couple of options in this situation. The first would be an appeal with the insurance company that declined your application. If possible, this appeal should include a letter from your new physician, in which he describes your current state of health. Then, add your own comments, very similar to what you have done here. You should also try applying with other health insurance companies. Not all insurance companies have the same underwriting guidelines, so just because this insurance company denied your application, does not mean that they all will. Along with the new application, you will want to include an explanation of the decline with this insurance company, as well as the letter from your new physician. The new insurance company will probably be aware of the decline by this insurance company because it may have been reported to the Medical Information Bureau and will part of your health history. All application for insurance will also ask you if you have been declined by any other insurance company, and you will need to answer that question honestly.
I live in South Mississippi. My Cobra will terminate June 08. Today in the mail I received a notice that the insurance company would provide insurance - but would place a rider - would not cover any disease or disorder of the heart or circulatory system. That does not seem too good for me. The company would consider the removal of the exclusion - subject to a statement of full medical recovery by a qualified physician at the sole option and judgement of the company. It sounds like I would be at thier mercy. Hypertension does not mean you have heart disease - it just puts in a higher risk - if not control. thanks for your comments so far.
Comment by mary — January 20, 2007 @ 3:34 pm
Well, this is a step in the right direction. Acceptance of coverage with a pre-existing condition elimination rider is better than a declination. However, we understand your hesitation in accepting this coverage under the terms of the rider. There a few things you need to consider before accepting coverage under those terms.
If you enroll in new health insurance, you will need to cancel your current COBRA coverage. If you decide to not accept the offer and keep your COBRA coverage until June, you will probably need to re-apply with the insurance company that is offering you coverage with the elimination rider. This is because your health status may change between now and June, and that insurance company will want to re-evaluate the risk factors. If, for some unexpected reason, your health status declines between now and June, they may refuse to offer you coverage altogether. Applications for health insurance, and any offers by the insurance company are usually only valid for 60 days. The letter you received probably has a deadline for acceptance of their offer.
If you accept the offer now, with the elimination rider, there is no guarantee if, or when, the insurance company will remove the rider. You are right in saying you would be at their mercy. If you re-apply close to June, and include the statement of full recovery, they may offer coverage without the elimination rider at that time. However, there is no guarantee of this either. This is a tough decision, because there could be pros and cons with any decision you make. It is impossible to predict what can happen between now and June. Under the worst case scenario, you will be able to obtain coverage under the Mississippi Comprehensive Health Insurance Association. This program provides “guaranteed issue” coverage to any person that has been denied coverage or offered insurance with underwriting restrictions, such as the elimination rider.
As we see it, here are your options:
Accept the offer with the new insurance company and cancel your COBRA. Pros: You will secure coverage for any unforeseen illnesses or injuries not excluded under the rider. Cons: There is no guarantee when they will remove the elimination rider and you will not be insured for heart and circulatory related illnesses until they do.
Apply with other insurance companies and try to find coverage without the elimination rider. Pros: You may be able to secure permanent issue coverage under more acceptable terms. Cons: If, during your search for other options, your health status changes, you may be left with no options other than those available through the Association. Your current offer may expire during the time it takes to explore other options.
Accept the offer with the elimination rider, and then try applying with other insurance companies. Pros: You will secure coverage for any unforeseen illnesses or injuries not excluded under the rider. Cons: You will not be able to apply for coverage under the Association under the federal HIPAA qualification that allows you to choose the option for immediate coverage for pre-existing conditions.
Exhaust your COBRA, accept coverage under the Association, and then try to secure individual insurance through a private health insurance carrier without elimination riders. Pros: You will be guaranteed coverage without the elimination rider. Cons: Premiums will be very expensive. Your health status may decline, and you will be stuck on the Association plan at these high rates.
We can’t advise you which of these options are the best because unforeseen variables can make any of them the wrong decision. The decision would be easier to make if you could be assured that there would be no decline in your health status between now and June, but that is impossible to predict.
Comment by admin — January 20, 2007 @ 5:46 pm
Thank you again for your comments. It is a hard decision to know what to do. I want to clarify that my cobra is good til June 2008. (18 months) The letter I received from the insurance company - stated we regret to inform you that we have issue your coverage with one or more endorsements and or riders effecting your coverage. Our
decision was made based on the following APS Dr.XXXX indicating hypertension. If I reapply with another insurance company do I need to get into all the other medical items the previous doctor noted? Especially if my new doctor finds my blood pressure fine. I plan to see her in two weeks. I have been keeping a record of my blood pressure numbers daily. Most doctors want to see this.
What are the look back limits in Misssissipp? actually what does this mean to me.
P.S. I have looked in the Mississippi comprenshensive health insurance risk pool association. One comment on this expensive, however it does cover drugs and doctor visits. It will pay 80% of charges. The negative item is there is no limit on out of pocket amount under this policy. but better than no insuarnce at all.
Comment by mary — January 21, 2007 @ 8:07 am
The look-back period in Mississippi is 12 months for individual health plan and 6 months for employer sponsored group health plans. This is the length of time, preceding your effective date of coverage, in which the insurance company may “look back” to review your health history to determine if a received claim pertains to a pre-existing medical condition. The insurance companies are provided this regulation on individual health insurance in order to protect them from falsified applications. On an individual health insurance application, as you have recently learned, you are required to disclose your health history. If a person neglects to disclose pertinent information, and there is a claim filed for that condition that was not disclosed, the insurance company is not liable for paying that claim. They also have the right to rescind the contract and cancel your coverage, but this is usually only done if the non-disclosure is blatant and the claim is substantial.
In regards to disclosing all of the information on a new application, which was noted by your previous physician: Yes, since the new insurance company will probably want to review the APS (Attending Physician’s Statement) as well. You can submit a letter of explanation along with your application, and even explain that another insurance company offered you coverage with an elimination rider, and that you are trying to find an insurance company that will accept you for coverage without this rider. Provide as much information to this new insurance company as possible, including your blood pressure charts.
Based on our experiences in dealing with multiple insurance companies across the country, you should be able to secure coverage without the elimination rider. It might be best to wait until after your next office visit, which should show your blood pressure as normal. If the insurance company can view medical records with positive reports, this will increase your likelihood of getting insured without the rider.
Comment by admin — January 21, 2007 @ 5:57 pm
Thank you for all the information. I plan to go to another doctor and try at a later date with other insurance companies. Also, any time I go to a doctor - I will request a copy of my medical information before I leave the office. I was not aware of what was in my medical records. silly me!!
Comment by mary — January 24, 2007 @ 8:35 am
I am in the process of filling out an application for insurance right now and from what I can tell, they didn’t ask me at all if I had been declined by other health insurance companies recently. Why is that? Some months ago I applied for insurance with Humana Health and were denied because of a spout of dizziness that I had about a year ago and talked to a doctor about. They choose to call it an undiagnosed condition. On my new application it doesn’t ask about dizziness at all or if I have been declined health insurance before. I was worried that might be an issue and that I would be declined again.
I don’t know if it is important, but I did have some help with my last application from an agent. He helped me fill it out. When I got denied and I told him, he told me write that I should write an appeal letter. Well, I did, and still got denied. I asked him what I should do from there, but I haven’t heard back from him since then. So I guess I am looking for a new one. I have tried to do it on my own, but I think I may need an agent. But if you could give me some information that would help me a lot!
Comment by Sheila — May 26, 2009 @ 10:26 pm
Was there a question on your application that asked if you have seen a physician for any other medical reason not listed on the application? This is a common “catch-all” question in which you would have ben obligated to disclose this history.
Comment by admin — May 27, 2009 @ 7:19 pm