AboutLinda Woolsteen Expertise I can help you with questions about health insurance. If you feel your insurance company is mistreating you. Are they telling you they are checking eligibity, pre-existing, etc. Or you just don`t understand how your insurance works or don`t understand what a PPO is.. I can help you.
Experience
Past/Present clients One company I worked for I was the underwriter for the Academy of Medicine of Cleveland and the Ohio Bar Association. I was also a supervisor of our customer service department.
Question I recently changed employers. At my previous employer we had Blue Cross HMO coverage for the whole family. My wife was prescribed Vicodin for migraine headaches by our family practitioner under the Blue Cross HMO.
Now we are trying to get coverage independently as my current employer has no medical plan. We have COBRA coverage if we want but it costs over $1000 per month, so we need to get a new plan ASAP. We applied to Blue Cross for a PPO plan and they have denied us coverage because my wife is taking the Vicodin prescribed by their doctor! I'm not very familiar with Health insurance policies so have no idea if this is normal or correct. How do we rectify this? Will all medical insurance companies give us the same problem? If so how can we ever get insurance again, as my wife cannot stop taking pain medication when she gets migraines.
Thanks a lot for any advice you can offer.
Answer Hi,
I just went through the exact same thing myself. I use to have migraines for the last 20 yrs and always had coverage through my employer. My company was bought out, we lost our jobs and I didn't/couldn't want to pay COBRA rates. I had always taken Imitrex for mine but presently have not been since they have seemed to finally go away.
I applied at United HealthCare for individual medical along with RX Copay Coverage. They approved me for the medical coverage BUT denied my RX/Copay coverage and issued the policy to me. The rate was pretty good so I just went with it for a month while I searched elsewhere.
I even appealed to them advising them that I do not have migraines anymore but they still wouldn't budge.
The RX/Copay card was important to me because being middle aged now and working for Insurance Companies, I have seen nationwide on a daily basis the drugs people have to take & their costs. So thinking as a precautionary measure, just incase I should need thyroid medicine or something else down the road I knew I wanted a RX/Copay card.
I applied with Medical Mutual of Ohio. They approved me and gave me the RX/Copay card and Dental that I wanted. They did however rate me up. Which means they are charging me a little more premium wise due to the past history of migraines.
Once you have been denied, rated or issued coverage with a rider. You are usually put into the MIB (Medical Information Bureau). Other insurance companies can check the MIB for your health history information.
I would say just to keep looking elsewhere with other companies.
Here is the breakdown of the way things go: When you apply, you go through underwriting. They will either approve you, deny you, rate you up or issue a rider.
Rating you up is charging a higher premium. Issueing a Rider means that they will have you sign a Rider that you understand that they will issue coverage to you but will not cover anything related to the specific condition that is a problem. (The wording varies on each companies Riders).
Once you have the coverage, your policy with have a Pre-Existing Time period. Usually, it is like 12/12, or 24/24, or 12/24. That means for example with the 12/12, that anything that you have been seen, treated or consulted for 12 months prior to your coverage effective date, will not be covered for the next 12 months. Once you are past that 2nd # (12 months in our example) then the pre-existing condition wil be eligible for review.
To help with the Pre-Existing Time period. Your previous carrier should have issued you a CCC (Certificate of Creditable Coverage). So, if you give your new carrier the CCC and they accept it, you will get credit for the period of time that is on the CCC. So, if you have 12 months credit on it from the last carrier, you will get 12 months credit on the new policy, meaning you will not have to wait for the pre-existing time period to end before the pre-existing conditions are eligible for review. ((Pre-existing and Underwriting) are two SEPARATE ISSUES.
If you are applying for a PPO policy in a specific state, such as MMO (Medical Mutual of Ohio) as long has they have a network PPO such as FIRSTHEALTH, you should be able to find provider (doctors, hospitals) that participate. But, if they ony offer you a network for a certain state then it would do you no good if the Insurance Company is in a different state.
Only other option that I know of is, when you work for a large employer you usually do not have to go through Underwriting where you have to answer the health questions. They just issue you the coverage due to the size of the group. That is why a lot of times when you have an older, retired couple, the women will go to work like at Macy's or somewhere, just to get healthcare coverage because their husband had a heart attack and cannot get coverage anywhere.
Hope that helps. Any other questions, let me know.
