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Health Reform 101

with Lisa Zamosky

WebMD helps readers understand their health insurance and the new health care reform law. The Affordable Care Act is bringing sweeping changes to American health care. Lisa Zamosky is here to help you navigate the health care maze and understand how these changes affect you.

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Thursday, September 29, 2011

Insurance Application Rejected for Migraines

By Lisa Zamosky

A reader of this blog posted the following comment/question in response to last week’s post about how to choose the best possible health plan.

“That makes the assumption we can get coverage. I was rejected for a history of migraines (otherwise perfectly healthy), and was told if one health insurance company rejected me they all would. Suggestions?”

Don’t Give Up

My first suggestion is that you should not assume that if one insurance company rejects you they all will.

Migraines fall into a category of diagnoses that will lead some insurance companies to deny you coverage. Others, however, may be willing to sell you a plan. The key to success has to do, in large part, with how well your migraines are controlled.

If you’re managing your headaches fairly well with an inexpensive medication, and you’re not regularly hospitalized or missing work because of them, with a focused search you may be able to find an insurance company that will work with you. Generally speaking, carriers are more inclined to cover someone with a clearly diagnosed illness that’s under control than someone who has a borderline condition that doctors can’t quite figure out and may lead to expensive treatments down the road.

Get Expert Help

Your best bet is to work with an experienced insurance agent who has a solid grasp of the underwriting practices of insurers in your area. Underwriting is the process through which an insurance company evaluates your age, gender and medical history to determine whether or not it will offer you a health plan.

Agents can help you decide which insurers you should apply to and then walk you through the application process and advise you about how to best deal with a follow-up phone call from a prospective insurance company (should you get to that point).

Calls are usually conducted by a nurse working for the insurer who will inquire further about your condition (Hint: Before getting on the phone to discuss your case, it helps to have in front of you a list of medical services you have used ).

You can find an insurance agent in your area by checking the National Association of Health Underwriters’ web site.

Next Steps

Even with well-controlled migraines, an otherwise spotless health record and the assistance of a veteran insurance agent, please don’t read my advice as a guarantee that if followed, you’ll be led to a land of rainbows and unicorns (and health insurance). The private health insurance market is notoriously rough and insurers are quick to deny people for even the most minor health conditions.

My real point is that given your description, it would be a mistake for you to give up trying to obtain health insurance and that you should absolutely give it your all before packing it in.

If you’re ultimately unsuccessful at finding a plan, however, I’ll mention (as I have in previous posts) the Pre-Existing Condition Insurance Plans (PCIP). These plans were created by the Affordable Care Act, set up to extend coverage for the medically uninsurable. They’ll function as a bridge until 2014, when insurers can no longer deny anyone coverage regardless of their medical condition.

The catch is that you have to be uninsured for at least six months.

In July, prices for these plans were reduced in most of the 23 states in which the federal government runs the PCIP program. States running their own PCIP were also given the option to cut prices. Check with your state’s department of insurance to find out about the details where you live.

You can also check the government’s web site to see what prices are in your state. And for information about how to sign up for a PCIP plan, visit pcip.gov or call 866-717-5826.

Best of luck! Let me know how it goes.

 SOURCE:

Healthcare.gov

Posted by: Lisa Zamosky at 8:57 am

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