shinyhappypeople Posted June 9, 2011 Share Posted June 9, 2011 (edited) It's actuary. Not actuarian. Sorry. Can't change the subject line :( Now, for my question/ vent: I was turned down for health insurance and I don't understand why. Maybe a former or current insurance person can help me understand why. It was a high deductible ($5,000+) but otherwise a decent plan, decent price. No coverage for anything pregnancy-related. Here's my boring health history: Seven years ago I went through infertility testing/treatment. Then, on my own, I got pregnant with DD#2 (We adopted DD#1). We're done TTC. I made this CLEAR on the application, even though they don't cover anything related to TTC or pregnancy. 1-1/2 years ago I had a UTI. I know, shocking and utterly unheard of and oh-so-rare. It was uncomplicated, treated with antibiotics, all better now. Twenty years ago, I had major depression and was treated by a therapist (no meds, though). No further treatment or issues with that. Fifteen years ago I had a "slightly abnormal" PAP smear. The results of a retest a few weeks later were 100% normal. So, maybe there was an error or something on the original test? No idea. Now I am, apparently, uninsurable. It would cost us almost $300 out of pocket to add me to my DH's insurance plan. That's NOT an option. We are relatively low-income and that's just not possible. I get the sense that if someone has EVER been sick for ANY reason they're suddenly uninsurable. But heaven help me if I get really sick. This stinks, especially because I don't understand what makes me such a terribly high insurance risk. Edited June 9, 2011 by shinyhappypeople Quote Link to comment Share on other sites More sharing options...
FairProspects Posted June 9, 2011 Share Posted June 9, 2011 Not an actuarian or anything, but did you have a C-section? I know in some states just having had a C-section can disqualify you from coverage if you are of child-bearing age, even when maternity is not covered. :grouphug:I'm sorry. It really sucks. I can't wait until 2014. Quote Link to comment Share on other sites More sharing options...
shinyhappypeople Posted June 9, 2011 Author Share Posted June 9, 2011 No, no c-section, no pain meds, no episotomy... total hippie birth ;) Thanks for the hugs, though. (Displaying my ignorance...) What's happening in 2014? Quote Link to comment Share on other sites More sharing options...
gardening momma Posted June 9, 2011 Share Posted June 9, 2011 Actuary, not actuarian. Sorry, had to put that in. Dh is one, but in automotive and residential insurance, not in health. :) Quote Link to comment Share on other sites More sharing options...
shinyhappypeople Posted June 9, 2011 Author Share Posted June 9, 2011 (edited) Actuary, not actuarian. Sorry, had to put that in. Dh is one, but in automotive and residential insurance, not in health. :) :D Fixed it. Wait, no I didn't. I couldn't fix the REAL subject line. Apologies to the actuaries among us. Edited June 9, 2011 by shinyhappypeople Quote Link to comment Share on other sites More sharing options...
QueenCat Posted June 9, 2011 Share Posted June 9, 2011 (Displaying my ignorance...) What's happening in 2014? Most of the Affordable Health Care Act will be enforced. Quote Link to comment Share on other sites More sharing options...
FairProspects Posted June 9, 2011 Share Posted June 9, 2011 In 2014, assuming the Affordable Health Care act goes into effect as is, insurance companies will no longer be able to deny anyone coverage. I did have another thought though, there is a stop-gap measure in place, but you have to have no insurance for 6 months (not sure how you feel about that). If you have been denied and have gone for 6 months without coverage, you can get coverage from your state's plan. I don't know how much the fees are though. You can check it out here by state: Pre-Existing Condition Insurance Plan Quote Link to comment Share on other sites More sharing options...
ColoNative Posted June 9, 2011 Share Posted June 9, 2011 Each state has different regulations. As a self-employed family, we always have to get our own insurance, so we understand what it's like... Here are a couple of thoughts - have you been without insurance? That is one thing they look for is the prior coverage. Also, did you ask why you were denied? They should at least be able to tell you that. If you don't like their answer, you can always ask for a re-consideration. Finally, each state has an insurance regulatory board that oversees all insurance. In Colorado, it's DORA (Department of Regulatory Agencies, which includes insurance.) I don't know if they will be able to help you, but might give some insight into the world of health insurance....hope that helps, and hope you'll be able to find suitable insurance! Melody Quote Link to comment Share on other sites More sharing options...
shinyhappypeople Posted June 9, 2011 Author Share Posted June 9, 2011 It just keeps getting worse. PCIP (the federal program) would cost a little over $300/mo. MRMIP (Ca's high risk pool) would be $741. Cool - except I CAN'T AFFORD IT. If I get cancer I'm SOL. If I get in a serious car accident it'll bankrupt us. I want to be responsible and have medical insurance but when I try it's totally out of reach. All because I had a UTI last year, had trouble having a baby 7 years ago (no longer an issue) and was depressed during college 20 years ago. No cancer. No heart attacks. No diabetes. Just had some normal bumps along the road that have been TOTALLY resolved... and yet the only way I can get insured is to pay the same premium as people with serious, chronic illnesses. Health insurance companies are scam artists. Why insure me for a basic, inexpensive policy when they can find any excuse at all to dump me in a high risk pool and make a ton more money of off me? Quote Link to comment Share on other sites More sharing options...
Desert Rat Posted June 9, 2011 Share Posted June 9, 2011 It's probably the depresion, even if it was 20+ years ago and you were never on meds. I was denied life insurance for the same reason. I don't mention it at this point in my life. Quote Link to comment Share on other sites More sharing options...
shinyhappypeople Posted June 9, 2011 Author Share Posted June 9, 2011 It's probably the depresion, even if it was 20+ years ago and you were never on meds. I was denied life insurance for the same reason. I don't mention it at this point in my life. Here's what's scary (and why I mentioned it on the app) they say that if they find out I've left off any medical information they will drop the coverage AND I'd have to pay back whatever they'd spent on previous claims. Quote Link to comment Share on other sites More sharing options...
abacus2 Posted June 9, 2011 Share Posted June 9, 2011 Are you in the recommended weight range for your height? Did you ask for an explanation and what did they say? Quote Link to comment Share on other sites More sharing options...
shinyhappypeople Posted June 9, 2011 Author Share Posted June 9, 2011 Are you in the recommended weight range for your height?Did you ask for an explanation and what did they say? My weight is fine. I don't smoke, don't drink. I've never had a chronic medical condition, except for the infertility which has been a non-issue for 7 years. In the email they basically said, "thanks, but no thanks." They'll be sending a letter, too, so maybe that has more details. I just.don't.get.it. Quote Link to comment Share on other sites More sharing options...
texasmama Posted June 9, 2011 Share Posted June 9, 2011 My money is on the depression and the abnormal pap. I had two individual health insurance companies turn me down because I give myself self-injected B12 for what is most likely perncious anemia, a treatable condition (and cheap to treat - about $30 a year out of pocket which insurance doesn't cover anyway). The third company rated me up. (charged me more to cover me) I am an otherwise healthy person. Are there other independent companies you can apply to? What about getting an independent insurance agent to help you? That is what we did. Quote Link to comment Share on other sites More sharing options...
shinyhappypeople Posted June 10, 2011 Author Share Posted June 10, 2011 My money is on the depression and the abnormal pap. I had two individual health insurance companies turn me down because I give myself self-injected B12 for what is most likely perncious anemia, a treatable condition (and cheap to treat - about $30 a year out of pocket which insurance doesn't cover anyway). The third company rated me up. (charged me more to cover me) I am an otherwise healthy person. Are there other independent companies you can apply to? What about getting an independent insurance agent to help you? That is what we did. That was my guess too, but... <buzzzzz> wrong answer! Just got the details in the mail and the reason they give is "history of infertility treated with clomid." (1) The policy doesn't cover anything at all related to infertility, pregnancy or childbirth (2) My cycles corrected themselves (no idea why) and I got pregnant on my own and now have a healthy, happy 6 year old to prove it. WHY THE *&^& DOES IT MATTER THAT 10 YEARS AGO I TOOK CLOMID FOR 2 CYCLES????? I'm starting to seriously flip out. I'm so MAD. This is so random and unfair. To have my prior infertility used against me is just mean. Especially when it has NO effect at all on my current or future health. I'm glad my kids are out of the house at the moment. I think I'm going to spend the next few minutes having a good cry and then DH should be home soon. I know it seems weird that I'm reacting so strongly. I usually just roll with the punches. Once I talk it out with DH I'm sure I'll feel better. It's just that right now I feel so .. I don't know. I can't articulate it. I need health insurance and nobody will offer me any that I can afford.. and they're denying me for a STUPID reason! It's just so frustrating!!! Thanks for letting me vent. (Kids just came home, I'll cry later) Quote Link to comment Share on other sites More sharing options...
Dana Posted June 10, 2011 Share Posted June 10, 2011 :grouphug: That stinks. Quote Link to comment Share on other sites More sharing options...
LittleIzumi Posted June 10, 2011 Share Posted June 10, 2011 :grouphug::grouphug::grouphug: I can't afford insurance right now either. I'm waiting for the PCN system to open up enrollment again, otherwise I have to wait until Jan to be able to even try the state-sponsored uninsured program (where we pay but they reimburse us). :grouphug: Quote Link to comment Share on other sites More sharing options...
Carol in Cal. Posted June 10, 2011 Share Posted June 10, 2011 WHY THE *&^& DOES IT MATTER THAT 10 YEARS AGO I TOOK CLOMID FOR 2 CYCLES????? Not to justify them, because I think that this is disgusting, but infertility treatments are very expensive. Maybe they are calling you a high risk for needing them again. I don't know. I don't like the health care reform proposal, but our current system is so bad. So many people can't get coverage. It's just terrible. I think that you should probably get on your DH's policy. At least they have to take you. It's too bad that it's so expensive, though. Do they have a high deductible option? My company does, and it's MUCH cheaper than standard health insurance. Or since you're here in CA, have you tried Kaiser? At least they are a nonprofit. Quote Link to comment Share on other sites More sharing options...
shinyhappypeople Posted June 10, 2011 Author Share Posted June 10, 2011 Not to justify them, because I think that this is disgusting, but infertility treatments are very expensive. Maybe they are calling you a high risk for needing them again. I don't know. I don't like the health care reform proposal, but our current system is so bad. So many people can't get coverage. It's just terrible. I think that you should probably get on your DH's policy. At least they have to take you. It's too bad that it's so expensive, though. Do they have a high deductible option? My company does, and it's MUCH cheaper than standard health insurance. Or since you're here in CA, have you tried Kaiser? At least they are a nonprofit. See, THAT I could understand... except the policy doesn't cover anything at all related to infertility, pregnancy or childbirth. It just makes no sense. I hate insurance companies. Can't afford to get onto DH's insurance. Don't have the extra $300 in our budget - not even close. No Kaiser nearby. :( :( :( But thanks for the sympathy, though. 2014 can't come soon enough. Quote Link to comment Share on other sites More sharing options...
NoPlaceLikeHome Posted June 10, 2011 Share Posted June 10, 2011 (edited) In 2014, assuming the Affordable Health Care act goes into effect as is, insurance companies will no longer be able to deny anyone coverage. I did have another thought though, there is a stop-gap measure in place, but you have to have no insurance for 6 months (not sure how you feel about that). If you have been denied and have gone for 6 months without coverage, you can get coverage from your state's plan. I don't know how much the fees are though. You can check it out here by state: Pre-Existing Condition Insurance Plan :iagree: History of depression often rules out people for insurance which stinks. Both my ds and I were turned for health insurance when we needed health insurance on our own. Thank God for health care reofrm and hopefully they take it further and do medicare for all:D :grouphug: Edited June 10, 2011 by priscilla Quote Link to comment Share on other sites More sharing options...
actuary Posted June 11, 2011 Share Posted June 11, 2011 I'm so sorry that you are having so much trouble with insurance companies:grouphug: I'm a property&casualty actuary so I don't have any inside knowledge about the health insurance world. This might be a really dumb question, but is there any way to appeal the decision? At least I'm thinking with the HMO I have now, whenever they make any decision, there is always a process to submit a formal appeal. Sometimes mistakes are made or unfair decisions are made and then appealing it makes them change the decision. Could you call and complain about the policy pointing out the unreasonableness of it (esp. since the insurance you applied for doesn't cover anything related to infertility, pregnancy or childbirth)? Sorry if this is a really dumb or really obvious idea - but maybe it was a blanket refusal without considering which policy you were applying for? Quote Link to comment Share on other sites More sharing options...
texasmama Posted June 11, 2011 Share Posted June 11, 2011 :grouphug: In your shoes, I would call and ask for the reasoning behind the decision since anything child bearing related it not covered. My wild guess is that they may be trying to lump you into the category of PCOS or something medically related which encompasses more than childbirth. In my experience, though, they can turn you down for any reason they want. It is arbitrary. I'm sorry. I have BTDT.:grouphug: Quote Link to comment Share on other sites More sharing options...
Carol in Cal. Posted June 11, 2011 Share Posted June 11, 2011 See, THAT I could understand... except the policy doesn't cover anything at all related to infertility, pregnancy or childbirth. It just makes no sense. Grrrrrrrrrr.... Maybe they are worried about ovarian cancer. Or maybe it's just the wrong phase of the moon. Sometimes it seems about that stupid. Quote Link to comment Share on other sites More sharing options...
Tap Posted June 11, 2011 Share Posted June 11, 2011 There have been some studies that show use of clomid increases the risk of ovarian cancer. So, it isn't the infertility being held against you, it is the use of clomid. There are other studies that contradict them, but with the decision up in the air, the insurance company doesn't want to risk the cancer possiblity. Quote Link to comment Share on other sites More sharing options...
asta Posted June 11, 2011 Share Posted June 11, 2011 There have been some studies that show use of clomid increases the risk of ovarian cancer. So, it isn't the infertility being held against you, it is the use of clomid. There are other studies that contradict them, but with the decision up in the air, the insurance company doesn't want to risk the cancer possiblity. I was just about to write this. asta Quote Link to comment Share on other sites More sharing options...
Dobela Posted June 11, 2011 Share Posted June 11, 2011 There have been some studies that show use of clomid increases the risk of ovarian cancer. So, it isn't the infertility being held against you, it is the use of clomid. There are other studies that contradict them, but with the decision up in the air, the insurance company doesn't want to risk the cancer possiblity. This. Also, women with infertility problems are at high risk for other health issues - such as needing hysterectomies at younger ages, PCOD related diabetes,endometriosis, and so on that can lead to a need of more medical care in general. It isn't the infertility that is the issue, it is the reasons behind the infertility and the meds you used with it that is most likely the issue. I do want to say that I feel your pain though. I went thru infertility issues and eventually had a hysterectomy at 35. After the hysterectomy it was suddenly easier for me to get private insurance. I would also ask about catastrophic polies that are intended to last just one year. The deductables are nearly the same. THat is what I use now for insurance. THe cost for me is about $200 a month and I have just renewed for another year with the same company. Quote Link to comment Share on other sites More sharing options...
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