What do I do if my Health Insurance is Denied?

If you have been denied for health insurance due to medical reasons, you don’t have to be uninsured and you don’t necessarily have to enroll on a high risk health insurance plan. Below are a number of alternatives to consider. Most do not involve medical review, so you could still qualify even if you’ve previously been denied coverage.

Denied Health Insurance

To download a printable version of this info-graphic, click Options When Health Insurance is Denied Info-graphic.

Group Insurance:

For many people, the next best thing to private insurance is group insurance. If you work for a company that offers business health insurance and you are eligible for coverage, consider applying. The premium tends to be slightly more expensive than for a private plan but it’s exempt from medical underwriting, so you can’t be denied health insurance. For more information, check with your employer. If you don’t qualify now, ask when the next open enrollment is. If you are the business owner, call a benefits specialist at 1-800-514-0958 to see how you can start a group plan with Kaiser Permanente.

Short Term Insurance:

Should group insurance not be an option and you are having difficulty finding other coverage, look into short term insurance. This is for people who need affordable major medical coverage in a hurry and who don’t mind having coverage for a limited period of up to six months. While you’re searching for the right plan, you can at least have some coverage in the meanwhile. Medical underwriting applies, but the criteria for deniable health conditions are not as strict. So even if you’ve been denied coverage for a regular health plan, you could still qualify for short term insurance. 

State Programs:

A variety of state-sponsored insurance programs are available. In California, for example, options include a plan exclusively for pregnant women, as well as high risk health insurance plans for people with serious medical conditions. To qualify for state programs, the family must meet the eligibility criteria for the specific program. Commonly, income requirements apply. In most cases, medical review is not applicable and you could still enroll even if you’ve been denied insurance coverage due to health reasons. Visit www.coverageforall.org for specific guidelines for the program that relates to your situation.

Other Alternatives after Health Insurance Denied

Sometimes, people shop for medical coverage because they are losing their group plan. If that is true for you and you applied for private insurance but were denied, then, additional options are available to you. Consider the following if your company health plan is being terminated and you’ve been denied coverage for a private plan:

COBRA (“Consolidated Omnibus Budget Reconciliation Act of 1985”):

COBRA coverage is available to employees and their dependents that are losing group health benefits. Exception: COBRA is not available if the company is being dissolved. Eligibility is unaffected by pre-existing conditions, so you cannot be denied for health insurance. On COBRA, you can continue the same health plan as under the group policy. Some drawbacks with COBRA are: It is temporary and the price will be much higher than when you were under the group policy.

Conversion Insurance:

Generally, a conversion plan is an option to switch coverage from a group policy to a private plan, without going through medical underwriting. The plans will vary between insurance companies. This article will address Kaiser Conversion Plans.

If you are losing your Kaiser Permanente group coverage, one of your options is to switch to a Kaiser Conversion Plan. Like COBRA, a pre-existing condition does not affect eligibility, so you won’t have your health insurance denied. Unlike COBRA, however, you can stay on a conversion plan indefinitely. The price is usually steep and the plan may not be the same as the one you had with the company.

HIPAA (“Health Insurance Portability and accountability Act of 1996”):

HIPAA coverage is probably not the first-choice for many people. It is exempt from medical review, so you can’t be denied for health insurance, however, there are other hoops to jump through. One of the main hurdles is that you must have been on COBRA, or similar continuation plan, and exhausted the insurance benefits in order to qualify for HIPAA. This means that after you lost your group insurance, you had to have enrolled on COBRA and exhausted those benefits before you could qualify for HIPAA.