Denied health insurance? Have you dealt with this?

[celestialdreamer]

We just found out that due to costs Dh's employer is cancelling our health insurance (Regence Blue Shield group plan). I started looking in to getting a individual plan for our family and realized that they will require health questionnaires from us. That is fine for all of us, except my 4yo who has Nephrotic syndrome.

After some research I found that his condition makes it so that he will be declined for private insurance. This is because the points system they use for grading these health questionnaires gives a VERY high point value to Nephrotic syndrome, because in adults it is extremely serious and costly to care for. This is not likely to be the case for our son, but the rules say that you cannot appeal to have a different score given for a diagnosis even if you have a "mild" case of something.

Our insurance likely will end July 1st and DH getting another job is not possible at this time. He works in a specialized construction field and in our area the construction industry is slooow right now. He's really lucky to have a job at all. I can't go back to work as we have 4 small children, 2 of which are special needs and we have a tiny baby. I guess there is some sort of special "high risk pool" for people that have been denied, but I don't know how we'd afford it in addition to a plan for the rest of the family.

Is there any avenues I've not yet thought of? Or just maybe some moral support from someone that has been there? DS being without health insurance is a terrifying idea. He is at high risk of a total relapse in the coming months/year and there is always the possibility he may not respond to his current meds and possibly even need chemo. I'm just really frustrated with the lack of options

[khaoskat]

Look up Obama's new Health Plan stuff. I do not believe you can be denied for a child any longer because of medical conditions/issues. I think that is one provision of the Health Care Reform Bill that went into effect almost immediately. They also cannot charge you higher rates for it, again per Health Care Reform.

[celestialdreamer]

Originally Posted by khaoskat

Look up Obama's new Health Plan stuff. I do not believe you can be denied for a child any longer because of medical conditions/issues. I think that is one provision of the Health Care Reform Bill that went into effect almost immediately. They also cannot charge you higher rates for it, again per Health Care Reform.

From the reading I was doing, I thought that didn't take effect for 6 months and only is meant for NEW plans. If only we could keep our current insurance another 6 months until that transition, ugh. I have a call into the state CHIP program to see if we qualify, if they have room and if they will take a child with a health condition like our son. I'm hoping to hear back good news.

[rainyday]

It looks like you're in Washington, so I would suggest contacting the office of the state insurance commissioner. http://www.insurance.wa.gov/

[Wild Lupine]

You can also look into your state's CHIP (children's health insurance program). In addition to taking kids whose families don't get employer-based health care, they insure kids whose insurance won't cover their medical expenses.

[RiverTam]

Originally Posted by onemomentatatime

You can also look into your state's CHIP (children's health insurance program). In addition to taking kids whose families don't get employer-based health care, they insure kids whose insurance won't cover their medical expenses.

This.

Here, in Illinois, you would be able to buy (decent!) insurance for him on a sliding scale basis through our CHIP program.

[MindfulBirth]

My daughter is denied private insurance due to her epilepsy. We tried our state's High Risk Pool insurance, but ended up having to pay $10,000 out of pocket that year for stuff they would not cover plus the overly inflated monthly premiums. Now I just have her on our state's medicaid program. Our neurologist is out of state, so we pay him out of pocket, but he gives us a huge discount on office visits and procedures done in his office.

[Shellie]

Cobra?

[Kristine233]

Does your state have a version of the Katie Becket insurance? Ours does and its called TEFRA it covers special needs kids whom otherwise wouldn't have insurance. Its based on income but you pay a sliding scale fee. Ours ended up to be very very affordable. Only the child with the special needs is covered though. The rest of the family would have to have other insurance. But if he was on that maybe it would bring the private insurance points down if you could prove he was covered elsewhere?

[mbravebird]

Have you seen this page?
http://hrsa.dshs.wa.gov/AppleHealth/am_i_eligible.shtml
It's the income eligibility for CHIP in your state.

Several years ago, when we faced what you are facing, we ended up having to reduce our income to make sure we met those income guidelines in order to have insurance for our son. His meds alone cost a half million a year, so insurance companies wouldn't touch us with a ten foot pole and the high-risk pool cost as much as one of our salaries.

Regarding the new health reform laws, my understanding is that new policies cannot deny children as of NOW. For adults, the wait is six months. So if you have the money for a private policy now, you should be able to do it. Otherwise, in four years, you will get subsidies to help you pay the premiums.

[celestialdreamer]

Originally Posted by MindfulBirth

My daughter is denied private insurance due to her epilepsy. We tried our state's High Risk Pool insurance, but ended up having to pay $10,000 out of pocket that year for stuff they would not cover plus the overly inflated monthly premiums. Now I just have her on our state's medicaid program. Our neurologist is out of state, so we pay him out of pocket, but he gives us a huge discount on office visits and procedures done in his office.

Good to know. I hope we don't have to go that route. DS's bills could be very expensive.

Originally Posted by Shellie

Cobra?

Nope, he works for a very small business (6 employees) and isn't eligible for COBRA. They are just trying to do all they can to cut costs to be able to weather the economic "storm" long term.

Originally Posted by Kristine233

Does your state have a version of the Katie Becket insurance? Ours does and its called TEFRA it covers special needs kids whom otherwise wouldn't have insurance. Its based on income but you pay a sliding scale fee. Ours ended up to be very very affordable. Only the child with the special needs is covered though. The rest of the family would have to have other insurance. But if he was on that maybe it would bring the private insurance points down if you could prove he was covered elsewhere?

Hmm, no I don't think WA has that, but I will check. Thank you.

Originally Posted by mbravebird

Have you seen this page?
http://hrsa.dshs.wa.gov/AppleHealth/am_i_eligible.shtml
It's the income eligibility for CHIP in your state.

Several years ago, when we faced what you are facing, we ended up having to reduce our income to make sure we met those income guidelines in order to have insurance for our son. His meds alone cost a half million a year, so insurance companies wouldn't touch us with a ten foot pole and the high-risk pool cost as much as one of our salaries.

Regarding the new health reform laws, my understanding is that new policies cannot deny children as of NOW. For adults, the wait is six months. So if you have the money for a private policy now, you should be able to do it. Otherwise, in four years, you will get subsidies to help you pay the premiums.

We fit within the guidelines thankfully, I'm just waiting to hear back on whether they will take new applicants, especially our ds. I'm not sure if they have any rules on who they will take. Honestly we can't afford a private policy, we were going to have to have a family member cover it for us if needed. If we can get all 4 of our kids covered by CHIP, we can afford by ourselves to cover a private policy for DH and I think. We were already on a tight budget, so this has been incredibly stressful to say the least.

Hearing that it was going to be such a total PITA to get ds covered is just such a kick in the gut after all the stress we've been through with his diagnosis last year. Thanks very much for all the responses. I'm hoping to hear back next week from CHIP.

[mamadebug]

We were facing a similar situation a while back. Our insurance was about to be dropped, I couldn't get a private policy (I had breast cancer a few years ago - totally cured though) not matter how much we were willing to pay, we didn't qualify for Cobra. There is also something called HIPA (maybe a part of the HIPPA privacy act, not really sure) which is the Health Insurance Portability Act. Contact a couple of insurance agents and they should know about it. I actually called Costco because they have health insurance policies. I wasn't able to get coverage through them because of my (now gone) pre-existing condition, but they gave me the name of an insurance agent who walked us through getting HIPA coverage. I can't remember the details now, but I think it was basically a sort of last resort type of thing for people who don't qualify for Cobra. It was going to be expensive, but not as expensive as I had expected.

Good luck. The idea of being without health insurance when you have had a serious health condition is so stressful.

[eclipse]

If they have room, they'll take him on the CHIP program. When we were on it, we didn't have to fill out any medical information. In California, though, there's a 90 day waiting period - the child is supposed to be uninsured for 90 days before they can be added to the CHIP program. If your state has the same laws, there might be an exception for your son if he has immediate medical needs due to his condition. It will probably be far cheaper for you guys to get all your kids on CHIP - not just this son, and then buy privately for you and your husband.