Options after a Health Insurance Denial

Health Insurance Denied
By Angie Perez

What do I do if I’ve been denied health insurance? Where can I go? Who will insure me? What are health insurance company’s requirements for someone looking for coverage? Do I qualify for coverage if I have a preexisting condition? If I’ve been denied for health insurance before, will I be denied again? All of these questions go through most shoppers’ minds as they begin the process of looking for insurance. Look no further; you will find all the answers to these questions by the time you have completed reading this little article. For information about your other options for medical coverage, click What to Do if Your Health Insurance is Denied.

Insurance companies want healthy people and they will do their very best to make sure you stay that way. If you are healthy, hardly go to the doctor (except for your physical) and have never had any issues, then you should have nothing to worry about when applying. Most insurance carriers’ underwriters will review your application and approve it with some ease. However, if you do have medical issues, and especially if you’ve had a health insurance denial in the past, it may take underwriters some time to review your application. They may need to contact your previous doctors and review lab results from past physicals before they let you know if you have been approved or denied. If you’ve been denied health insurance before, you might still be eligible. It depends on factors such as: if you still have the medical condition, the severity of the condition, and how long ago you were denied for health insurance.

As a Health Insurance Enrollment Specialist, I have heard the feeling of rejection on the other line when someone hears their application was denied for health insurance coverage. This feeling of rejection based on a condition that was not their fault (or that they planned on) is not necessarily the end of the road; simply, it is just one door that has closed on the journey to health coverage. Listen…a few other doors are opening!

“What are the other opportunities opening up?” you ask. One option is to submit a health insurance appeal, which can be submitted when you receive an underwriter decision that seems inconsistent with your medical history. The denial letter from the insurance company should state how much time you have to be able to appeal and the steps you need to take. Misunderstanding or just missing information is sometimes the reason for denials. Give them all the facts so that they can review and make the proper decision. Tip: Consider including with your health insurance appeal a statement or explanation letter from a medical professional. For Kaiser Permanente, another door opens if you own your own business. Being a business owner, you are not required to go through the medical underwriting process, you simply need two people connected to the business and some eligibility forms filled out and you can have coverage by the beginning of the month. Apart from that, there are government programs that require a health insurance denial in order to apply. In California, visit mrmip.us to get more information about the Major Risk Medical Insurance Program (“MRMIP”). Can you hear it now? Doors are unlocking for you!

Hey, having a health insurance denial is not the worst thing to hear. My uncle used to tell me, “The worst they can say is ‘no’, and that isn’t the worst.” So I’ll keep knocking until the right door opens. Never stop, never give up! The right door is just up ahead.

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