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My 60 year old mother recently sold her house and left her job on the east coast and now lives with us and is our nanny. We naively thought that she could just buy health coverage when she is no longer eligible for COBRA (next August)until she qualifies for Medicare at 65. She applied for an individual plan through Blue Cross and was flat out denied. She spoke to an insurance agent who said she was uninsurable because of the amount of medication she takes. He said she may be able to get an expensive ($1000/mo +) policy that would cover catastrophic illness or injury but not regular doctor's visits or meds. Her meds are for bi-polar and an underactive thyroid. Is it true that she will never get good coverage? She is very stable but we are considering asking a phsyciatrist to say she is disabled by her bi-polar so she will qualify for medicare. I don't see any other options but I really don't know much about how our broken healthcare system works. Thanks. Elizabeth
My friend's newborn has the sickle cell trait but only from one parent so it will not develop, she only
will carry the gene. I am wondering if anyone can offer advice as to what insurance will provide for her
because their current insurance (blue cross, I believe) won't take the baby. Please share any information
on why the insurance refuses to provide for this child or any similar experiences with sickle cell. Thank
A concerned friend
Our family of five is currently on COBRA with a monthly premium of almost $1400. We have been denied private insurance through blue cross and blue shield for having very minor chronic problems. Someone suggested that I look into health plans offered through trade or industry associations. I also read on the internet about the scams that are operating as insurance. 1) does anyone have any knowledge of whether this is really a viable option to pursue. does CA regulate these entities? 2) can anyone recommend an association which has good coverage. Between my husband and I we have enough degrees and job experience that we may actually qualify to join one of these. Thank you in advance for your help. This is pretty scary.
The Department of Managed Care - CA has strong guidelines about the collection of information and health insurance consumer resources (not just HMOs) CA has more publicly available informatin than any other state: http://www.hmohelp.ca.gov/
General info on getting smart about health care (note: the Kaiser foundation is NOT affiliated with Kaiser health plan they share the name only): http://www.chcf.org/ http://www.kff.org/
Good luck - I know it's tough Lily
When my partner was recently laid off, our family went on COBRA health insurance. Because of the high cost of COBRA, I tried to switch my whole family to Blue Shield, but they wouldn't accept my daughter because she has had some health issues. COBRA will run out eventually, and I'm very worried about my options for insuring her. Can anyone provide any advice or suggestions about how to insure a child who has health issues? Thanks. Anonymous, please.
If your daughter is disabled, she may be eligible for Medi-Cal. She can also continue past the COBRA expiration for coverage for the disabling condition only. You will need medical verification of disability.
If she is not disabled, she may be eligible for Healthy Families, but you have to have a relatively low family income. (You said ''partner'' and not ''spouse'' -- I'm not sure if ''family income'' would need to include a technically unrelated adult). Info can be found at http://www.healthyfamilies.ca.gov/. There is also something called the Major RiskMedical Insurance Program, which provides insurance for people with pre-existing conditions. I do not think it is at all low cost. Info at http://www.mrmib.ca.gov/MRMIB/MRMIP.html. That all said, you may want to apply for a Kaiser individual plan. A few years ago, when I was shopping for insurance, I was turned down by both Blue Cross and Blue Shield due to my medical history, but Kaiser accepted me. Good luck. M.S.
FYI--when we were struggling with insurance options we found Bill Killips an invaluable resource. He is an insurance agent a friend referred us to. For a few weeks while we were considering our options he consulted with us and gave us the benefit of his knowledge of the industry, including the complicated COBRA regulations. He is one of the cheeriest and most positive people I've ever known, and is very prompt in returning phone calls. We always felt like we were a priority, and we weren't even his clients (yet!). Of course once we determined what was best for us we wanted to work with him and he continues to provide us with excellent service. We think the world of him. His phone number is: 925-906-4618 (Walnut Creek). Christina G
A month or so back I asked the list for recommendations about self-payed health insurance for our family -- my husband was recently laid off and he and I are now both self-employed. The consensus of the list seemed to be that Blue Shield was the best bet, and we liked the terms of their plan a lot. But while my son and I have been accepted, they have denied coverage to my husband because -- get this -- he has hay fever and high cholesterol and admitted to seeing a chiropractor now and then. So now what do we do? He's really panicked -- losing his job was bad enough, but now to feel like he can't get health care is really scary. Kaiser is an option, although we're a little worried he may get denied there too, and he really likes his non- Kaiser primary care doc.
So here are my questions: what do you do if you're denied coverage? Are there other health plans that may be more receptive than Blue Shield was of a perfectly healthy 42 year old man who gets sneezy in the springtime? Should we have omitted more information on the application? Is there any way of appealing a denial? Any advice/recommendations would be much appreciated. Nelly
1. We used an insurance broker named Forrest Lupo. I don't have his phone number, because it's in my husband's work phone book, but if you want to contact me personally, I'll get it for you. He really went to bat for us in a most gracious way, and walked us through processes that contested the insurance denial.
2. Following Forrest Lupo's instructions, we had my doctor write a letter to Blue Shield saying that I was in good health and that the issues mentioned (a knee injury for which I was no longer receiving any treatment whatsoever) posed no foreseeable problems.
Insurance companies are so avaricious that working with them is really like making a deal with the devil, but we have insurance with Blue Shield now and it really is better than the alternatives we otherwise considered. elza
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