Health Insurance Navigator

By Lisa Zamosky

I recently wrote about a survey that brought attention to the high rate at which people who try to buy health insurance on their own are declined. The story clearly resonated with readers, many of whom left comments sharing their own experiences about being turned down by a health plan.

One of the recurring themes in readers’ comments was how many people had minor ailments – or what they perceived to be minor – and were baffled by the fact that they would lead an insurance company to deny them access to coverage.

I thought it would be useful to highlight the situation of a few readers and to get an expert’s take on what might be behind the rejection, as well as what, if anything, consumers can do to increase their chances of qualifying for health insurance.

Rejected for Attention Deficit Disorder

One young woman now 26 who is no longer able to stay on her parents’ health plan said she was declined coverage for a diagnosis of Attention Deficit Disorder, which she received years ago.

“I was shocked. How can this be an issue?” the young woman, named Sarah, wrote.

Although a diagnosis of Attention Deficit Disorder seems minor, it’s not, says Carrie McLean, consumer specialist with ehealthinsurance.com, an online health insurance market.

“There are many risk factors involved, as well as the cost of the medication that deem this a declinable condition,” McLean says.

Another reader said that she had been incorrectly diagnosed with an illness years earlier and had been denied coverage because of it.

“When someone gets wrongly diagnosed it needs to be corrected in their medical records,” McLean says. “There is an appeals process that every carrier has so when this happens the customer can go through that process to get it fixed.”

McLean likens this last situation to an item on your credit report that is not correct and is causing you to be denied credit. You can read this previous blog post for information about how to gain access and make corrections to your medical records.

Move On and Try Again

McLean points out that the underwriting guidelines for each insurance carrier differs. “Don’t assume if you received a rejection letter that every carrier will do the same,” she says.

But you also don’t want to start applying to one insurer after another. Each will know how many times you’ve previously attempted to get coverage and were denied. The more denials you have on your record, the harder it may be to find a health plan. This situation calls for strategy.

As I’ve suggested so many times before, if you’ve been denied coverage, work with an insurance agent for help. Some insurers are softer on certain diagnoses. An experienced agent will know which health plans in your area are more likely than others to sell you a plan based on your individual circumstances.

To find an agent, you can log onto ehealthinsurance.com or call their toll-free number to speak with a licensed agent: 1-800-977-8860. You can also find an insurance agent in your area at the National Association of Health Underwriters website.

And remember, starting January 1, 2014, insurance companies will no longer be able to deny anyone coverage, regardless of their medical condition.

Share your experience: Have you been denied health insurance by one carrier but then gone to get coverage from another? Tell your story in the comments section below.