Declined for Minor Conditions?

[matilda654]

A friend of mine was declined for Major Medical insurance with Celtic. Her Cobra insurance is expiring this month, so she needs to get an individual major medical plan.

I do not understand why she was declined. She has none of the major health issues, such as heart problems, hight blood pressure, diabetes, high cholesterol, etc.

She has hemorroids, fibroids (which will shrink once she goes thru menopause according to research), and had migranes about 10 years ago, otherwise is healthy and does not go to the doctor on a regular basis for any recurring problems, nor does she take any perscriptions.

Are insurance companies getting that strict to where they don't approve applications unless you have NO conditions whatsoever? I am very frustrated for her. Any suggestions. She did call the insurance company and they were of no help and just suggested she write a letter of appeal, which we are both sure will be a waste of time. She lives in TX and has had insurance her whole life, and wants to find insurance coverage.

 

[Guest]

My advice, get her to get a letter of explanation then prescreen with other carriers while she appeals. There might be more to this than she is saying, that is usually the case, although we have had declines and rate ups overturned, so this just might be an error, or a code problem with a medical record, could be anything. Don't blame the insurance company just yet.

 

[STIBROKER]

A friend of mine was declined for Major Medical insurance with Celtic. Her Cobra insurance is expiring this month, so she needs to get an individual major medical plan.

I do not understand why she was declined. She has none of the major health issues, such as heart problems, hight blood pressure, diabetes, high cholesterol, etc.

She has hemorroids, fibroids (which will shrink once she goes thru menopause according to research), and had migranes about 10 years ago, otherwise is healthy and does not go to the doctor on a regular basis for any recurring problems, nor does she take any perscriptions.

Are insurance companies getting that strict to where they don't approve applications unless you have NO conditions whatsoever? I am very frustrated for her. Any suggestions. She did call the insurance company and they were of no help and just suggested she write a letter of appeal, which we are both sure will be a waste of time. She lives in TX and has had insurance her whole life, and wants to find insurance coverage.

who did she apply with.......

 

[leevena]

You may want to focus on the fibroids. Fibroids is the leading cause (33%) of hysterectomies in the US.

 

[Guest]

You may want to focus on the fibroids. Fibroids is the leading cause (33%) of hysterectomies in the US.

That's true, didn't see that. Have had declines for uterine fibroids.

 

[somarco]

Use a carrier that riders. At least you should be able to get an offer.

 

[matilda654]

You may want to focus on the fibroids. Fibroids is the leading cause (33%) of hysterectomies in the US.

She is 56 years old and about to go thru menopause and has
no intentions of having a hysterectomy. Plus after doing research, a woman's fibroids shrink after menopause.
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who did she apply with.......

She applied with Celtic Insurance Co. also applied with Aetna before she started her Cobra and was declined with them also.

 

[STIBROKER]

dang...celtic is suppose to have the loosest underwriting.....

 

[somarco]

She is 56 years old and about to go thru menopause and has
no intentions of having a hysterectomy.

I talk to folks all the time that are planning on losing weight, going to quit smoking and going off BP and cholesterol medications (with doc approval).

Until they actually do that the underwriter will base the decision on what exists and what could happen going forward.

 

[Bob_The_Insurance_Guy]

She is 56 years old and about to go thru menopause and has
no intentions of having a hysterectomy. Plus after doing research, a woman's fibroids shrink after menopause.

Is that internet research? Is it research done in this country? Does it have 10 to 15 record of fact to back it up? Have these facts been submitted to the insurance industry for verification? Has it gone through research trials?

I don't mean to sound harsh, and I hope this is not the case here, but "research" usually means someone has gone to webmd, seen some internet columns written by docs and taken that as gospel.

There are TONS of commercials on TV about medications that a woman can take for uterine fibroids. "Ask your doctor if ______ is right for you." For an insurance company, that is an immediate and ongoing claim. There are such things as flare ups.

I also agree. There might be something below the surface, we don't know about.