How to get individual insurance with a pre-existing condition?
Asked by
PupnTaco (
13895
)
November 10th, 2009
from iPhone
I have a friend here in California who is self-employed. She had COBRA health insurance coverage through her ex-husband’s employer. She missed a payment and they cancelled her without notice on August 31. She didn’t realize her coverage was gone until November 3. She appealed and was denied.
An insurance broker told her after 60 days she’s out of luck to be grandfathered into a new plan based on her COBRA coverage.
She has a pre-existing condition (diagnosed bipolar) and must take meds, which are running out now.
Is her only option to get a job at Starbucks just for the insurance?
Any ideas would be appreciated.
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5 Answers
Good luck. Talk to the Republicans (who don’t have that problem based on their government backed health care.)
Tough problem. COBRA was going to run out eventually, so, this was going to be an issue either way. She might want to go the “Starbucks” route since her premium will be super high if she can even find an insurer.
Can she pay for her own meds? I know they can be pricey. Some pharmacies offer prescription plans or there are other script plans out there. I know a psychiatrist who is great with non-insured patients. PM me if you like.
Getting Canadian citizenship might be a good idea…
This is a tough one. The best way for her to get insurance now will probably be to get herself an advocate. Does the doc who prescribed her meds have a Patient Services Coordinator or Referrals Coordinator? Your friend should cultivate a friendly relationship with this person, and ask him or her to do another round of appeal, sending detailed records of her condition and a second, more forcefully worded, letter of medical necessity from the doc. Referrals Coordinators like me sometimes have friendly relationships with the people who make the decisions on the insurance company’s end. However, if this situation has gone far enough up the food chain to be a denied appeal, your friend’s case may have drawn too much attention for those lower-down to be able to affect the outcome.
If this doesn’t work, your friend is probably SOL as far as insurance is concerned. Then she can only follow tinyfaery’s good suggestion. Another way to get meds is to talk to the psychiatrist and get samples (limited supply of meds drug reps give docs to give patients sans prescription).
I once ran into a problem with medical insurance and I didn’t have coverage. I was in my early 20’s and was stupid to think I was invincible. I ended up needing surgery which turned out to be a pretty penny. I was able to call the hospital and make arrangements of partially paying each month. By law they can’t report you if you are making payments and it’s for medical reasons. I am
still paying it off to this day. For prescription drugs, I would probably have her talk to her pharmacy and see if they have plans. If all else falls go to the public treatment centers that are run by the government. They will put her on her medication again and steer her in the right direction.
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