Anthem denied DD insurance.

[CathyA]

DD just turned 26 and wasn't allowed to be on our Anthem BCBS plan anymore. So she applied for her own with them.
Last year, she had a rough spell......she had bad roommates, had bedbugs, failed her masters recital because of a lip problem she had developed and developed a vitamin D deficiency, which contributed to some depression. But she handled it all great. Yes, she found a therapist to talk things through with. She moved into a different apartment, worked hard to get rid of the bedbugs, worked very hard to re-learn how to play her instrument in a way that wouldn't injure her lip, took vitamin D supplements and passed her Masters recital with flying colors. We are very proud of how she handled these very difficult situations. Well, Anthem BCBS rejected her because she had "severe depression". The BCBS agent told her to get a signed document from her therapist, that she didn't have severe depression. She got that and sent it almost 3 weeks ago. Also, she's never been on any psyche meds. She finally heard today that they thought she was too big a risk. WTF??

She lives a very healthy lifestyle and works hard every day. This really pisses me off.
We've told her to get an insurance agent who will be her advocate. This seems so wrong to me. I think we will help her challenge this.
Unfortunately..........she has no insurance while we try to figure all this out!! :devil:

[ApatheticNoMore]

It's not personal, they aren't targetting her specifically because she had "mental problems". It's just the old preexisting conditions game, and if that seems wrong just think of other (minor and treatable!) conditions where people may be deemed to have pre-existings through little fault of their own, things like low thyroid that merely needs meds. The way to have avoided it, of course, is to have paid for the therapy out of pocket (I'm assuming that's how they knew, the insurance was used to pay for it, because shrinks don't just file with the insurance otherwise), of course that's not always affordable. I had a doctor (for minor physical problems) that was very reluctant to prescribe with a med that might work, even though I kind of wanted to try it and see, because it would mark me as preexisting. I'm very grateful for that wonderful doctor. Yea look into an insurance agent or other insurance options, I doubt it even makes sense financially to deny a 26 year old with a treatable preexisting insurance (an older person with multiple serious problems maybe but), time is on her side but she might need to pay a little more.

[catherine]

I should probably know this, but is anyone familiar with Obamacare policies related to pre-existing conditions? That was a major tenet of his plan and not sure where your state will be with regards to administration of it. But here's an interesting article about Obamacare/pre-existing conditions, from a California residents perspective. (http://www.healthycal.org/archives/10240)

It's possible that your DD might be without insurance for 6 months, but then would qualify for a PCIP plan.

Just for the record, call me a bad parent, but two of my kids have no insurance, and because they're adults, I consider it to be their problem. I don't worry about it. I've gone through long periods of my own life without it, and have survived. As important as health insurance is, sometimes I think it's overrated--especially if you're very young and very healthy.

[CathyA]

Thanks ApatheticNoMore and catherine.
If something happens to her, we would be the ones to help, and then we'd be destitute. :(
At least she has some medical coverage through her auto insurance.
But what if she would break a leg, and then it would get infected, and then she would get septic and need a critical care for 2 months................
I know that's the worse case scenario, but it could happen.
We'll see what her new agent has to say.
And you can't say to the insurance co. "I'll pay all my mental health bills". They don't allow that.

[catherine]

Thanks ApatheticNoMore and catherine.
If something happens to her, we would be the ones to help, and then we'd be destitute. :(
At least she has some medical coverage through her auto insurance.
But what if she would break a leg, and then it would get infected, and then she would get septic and need a critical care for 2 months................
I know that's the worse case scenario, but it could happen.
We'll see what her new agent has to say.
And you can't say to the insurance co. "I'll pay all my mental health bills". They don't allow that.

Cathy, I certainly understand that bad things can happen--I just tend to typically err on the side of "why worry about things you can't control." All I'm saying is, if she has to wait a few months to get insurance, chances are she'll be fine.

But do check into the Affordable Care Act in your state

[treehugger]

It's my understanding that requiring insurers to disregard preexisting conditions for adults doesn't go into effect until at least 2014. My memory isn't good enough to remember the exact date. But anyway, yes, it's not personal. This is how insurers have always done business, and it's scary for anyone who has lived a life (aka, a preexisting condition) but is not on a group plan/employer plan.

My husband and I both have huge preexisting conditions (his kidney disease; my kidney donation) that would mean we wouldn't be able to get any insurance if I were to lose my group plan through my employer. I am so relieved this will be changed, thanks to the ACA, but unfortunately, we aren't there yet.

Kara

[catherine]

Here are two websites:

This one (https://www.pcip.gov/) states that unfortunately, as of only last Saturday, they are no longer accepting PCIP applications until further notice.

This government website (http://finder.healthcare.gov/) gives you some other options. Hope it helps!

[Life_is_Simple]

It's my understanding that requiring insurers to disregard preexisting conditions for adults doesn't go into effect until at least 2014.
Yes, Jan 1, 2014. At this link (http://thanksobamacare.org/index.php?s=timeline), click on 2014 year, and it is first bullet point

[ApatheticNoMore]

And you can't say to the insurance co. "I'll pay all my mental health bills". They don't allow that

You can pay by cash/check for many therapists and if you don't give them your insurance info they'll never know, there's simply no insurance company to report to (and most shrinks will be happy not to have to keep track of things for insurance!). Psychotherapy is still in large part a cash business. Of course that's all water under the bridge.

As for the 2014 law and preexistings, I'm not sure there is anything preventing insurance companies from charging more for people with preexistings, I think it just prevents straight out denial of coverage for preexistings. I could be wrong.

[Tammy]

Think of it this way ... If she spends 2 months in ICU, she is an adult. You don't have to pay her bill. Every hospital has a program to assist those without resources. She accepts that help. Then se negotiates payments on the balance.AAs low as her budget requires. As long as she makes payments, most hospitals are satsfied. It can take decades ... but they dont mind.

[catherine]

Thanks, Life_Is_Simple: I also saw that website.. on the 2010 tab there was recourse for government-sponsored insurance for pre-existing insurance starting in July 2010:


The Pre-existing Condition Insurance Plan offers coverage to people who have been uninsured for 6 months because of a pre-existing condition

But they are no longer accepting applicants, unfortunately.

[catherine]

Think of it this way ... If she spends 2 months in ICU, she is an adult. You don't have to pay her bill. Every hospital has a program to assist those without resources. She accepts that help. Then se negotiates payments on the balance.AAs low as her budget requires. As long as she makes payments, most hospitals are satsfied. It can take decades ... but they dont mind.

+1

ETA: My mother had brain surgery and recovered from it, and had no means to pay. I was not responsible for any of her bills. The same would be true in a parent/child situation if the child is an adult

[Gardenarian]

Would your daughter be eligible for Medicaid?

[Lainey]

Would your daughter be eligible for Medicaid?

Single childless adults don't always qualify - depends on your state. During the budget crisis, AZ dumped all single childless adults from AHCCCS, which is what we call Medicaid here. I believe they recently allowed them back on the list, but I'm not completely sure that's the current status.
The other thing is that a number of hospitals are quietly closing their ERs, which is where a lot of uninsured routinely go.

2014 can't get here fast enough for a lot of people.

[befree]

Has your daughter shopped around for a high-deductible plan, which would only be necessary for catastrophic events (like the broken leg with sepsis and ICU you mentioned?) Just because she was denied by one company for one type of insurance program doesn't mean she doesn't still have lots of options.