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Health Insurance California Cobra Question & Answers

2014 February 4
by Sarah Fields

Michael asks…

How to appeal declining application on Health insurance?

I just received letter from Blue Shield of California on my recent application for health coverage, I am asking for any suggestion on appeal and my rights in this process. My COBRA is running out, and this recent application took 2 months before they turned me down.

I considered myself fairly healthy other than a monthly low dosage cholesterol prescription.

Any help or suggestion is appreciated.

Sarah Fields answers:

Bad cholesterol readings would not be subject to a decline; worst case scenario would be a waiver. There has to be something else in your records that would indicate another problem and the letter should state the reasons, such as being over the BMI guidelines or needing a procedure that has not been completed. You need to contact your agent. The agent can talk with the underwriters and help you appeal the decision or can suggest other options. If the agent also works with other insurance companies they can probably find a plan that would accept you; many other companies are much more lenient with their underwriting. If you did not use an agent you’re acting as your own agent and you must contact the underwriters to find out why they declined and what your options may be.

Richard asks…

What insurance company will cover me?

I am a diabetic with possible bladder cancer, my husband just divorced me and I am stuck with Cobra with the amount of 626. a month. I am a single mother of two girls and I need HELP.

Sarah Fields answers:

COBRA is the attempt to cover you. Welcome to the need for health reform. Often there is help on the state level too. It matters where you live. In California there is help available and I am sure there is in most other states. You need to talk to a social worker in your area.

In Georgia you would go to the Department of Family and Children’s Services. You can start finding help online by typing Food Stamps Atlanta Georgia into your browser. Look for links with the .gov instead of the .com extension. I tried this and found a great answer in Yahoo Answers by a former employee of that department. By going to an agency like Children and Family Services, they act as gatekeepers that can put you in touch with other sources of help.

Connect with legal aid to find out how to get child support if the father of your children is employed. Having COBRA makes me think that you are unemployed rather than him. California has specific
programs for medical help for children. In sources below there is a link to the Georgia program for enforcing parental support. Check to see if something is available in your state that is similar by typing: Child support Georgia (or whatever your state is) into your browser.

Is there a medical or dental school in your area? Call them to see if they have free or low cost children’s, diabetic, cancer, or renal clinics available. Keep asking every time you connect with a human being at one place, where you can find more help. They may have answered the same question lots of times.

Robert asks…

How do I find Insurance coverage for preexisting conditions in California?

Our March Cobra payment was sent in too late so the coverage was cancelled. I applied on-line for coverage with Blue Shield of California and was denied due to preexisting conditions. Now I have no coverage. I understand I may have a 6 mo. to 1 yr. period where the insurance wont cover any preexisting conditions once Im on a plan, but how do I find a plan that will accept me?

Sarah Fields answers:

Private insurance doesn’t quite work that way. With a private policy, they can totally exclude the preexisting condition, forever. The waiting period, is only for preexisting conditions on a GROUP policy.

You probably need to sit down with a local agent, but depending on the seriousness of the preexisting , you might not find any private company willing to insure you, even with exclusions.

You should probably look at the California High Risk Health Plan, but it can be pretty pricey – for family coverage, it’s up to $6800 per month, depending on the age of the oldest person. Here’s a link to the site: http://www.mrmib.ca.gov/MRMIB/MRMIPBRO.pdf

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