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Hi Everyone,

Thank you for your comments regarding this subject.  It appears that others 
are having similar experiences regarding health insurance.  Below are excerpts 
from your messages that may be helpful:

"My husband and I recently tried to apply for different coverage within the 
same health insurance company here in Montana.  It is a Montana-based 
company.  I was denied and the two reasons cited with a history of Celiac 
Disease and Nabothian Cervical Cysts (which are common in women, but benign 
and very rarely cause any problems).  I was told the decision was based on a 
common point system they use provided to health insurance companies.  I did 
some research and then wrote back to the insurance company, citing facts about 
both celiac and the cysts and asked that they reconsider.  They won't!"


"I was not denied Health Insurance. They simply refused to pay anything GI 
related for 1 year. After the year was over, they would re-evaluate. But the 
carrier was not BC/BS. Fortunately, My husbands employer was having trouble 
attracting new employees because they didn't offer Health Care coverage. They 
finally implemented health care policy and all was well. We were able to get 
coverage through his employer and the HC plan was through BC/BS. I would 
suggest they your friend simply say she is allergic to wheat instead of 
letting them know he/she has celiac disease. Anytime one out disease on 
anything it sends up red flags. If you say you have an allergy, or say your 
gluten intolerant  they usually don't think twice. Your friend may want to 
appeal by telling them as well as showing them documentation that her 
condition is under control."

"I would suggest she contact the benefits security administration first. 
They were a tremendous help to me one time when Cigna tried to deny me 
benefits and they found a loop hole for me. There are many laws and 
loopholes out there that the average person doesn't know about and the 
health insurance companies will try to get away with cause they know nine 
times out of ten, they can!! I fought it and won! and the representative 
involved with the security administration was extremely helpful and went to 
bat on my behalf....good luck, I've included the weblink: 
http://askebsa.dol.gov/"

"I wasn't biopsy confirmed, so when I applied I just put down "gluten
intolerance".  That was a couple years ago, I think before they even cared
about CD.  Talking to an independent agent is helpful as far as what words
they give more scrutiny to. I had trouble getting insurance because of back
problems, the agent told me to write "backache" instead of "back pain"
because that is a phrase that catches the underwriter's eye.  It's very hard
to get independent coverage, unfortunately.  I know people who have gotten
turned down just for having allergies.

Another thing I did was that if one thing I had been treated for was a
symptom of another thing I had put down already, I tried to not put it down
again and have it be two hits against me for just one problem.  Hypothyroid
and celiac had to be separate, but celiac and nutritional deficiencies are
definitely under the same umbrella.  He can run that by an agent to make
sure it's all done correctly without tripping over any traps so to speak.
Unfortunately, I think most applications ask if you've been turned down
befor and why... so he may want to look into working with BCBS to review it
again."

"insurance companies will not insure us on an individual plan.  The company my 
husband is with is changing many of their policies to include diseases that 
have not been covered in the past."

"I suggest that she speak to an attorney knowledgeable in the area of
health insurance law.  In the alternative, she should call her local
government's health insurance regulatory agency.  

Also, I found this website, for individuals who cannot obtain other
insurance due to a "high risk status."  However, I would strongly
suggest that she consult with an attorney before trying this option -
as it will make it difficult for her to get insurance in the future,
and is likely not transferable if she were to move, as it is
administered by the state of Missouri.  http://www.mhip.org/.

If she wants to contact an attorney, here is a good place to start:
The American Bar Association,
http://www.abanet.org/legalservices/findlegalhelp/home.cfm."

"I feel is the worse for writing policies
they add for everything,
exclude everything and charge you many bucks
I was charged $964 for me alone every 2 months
and to top it all off, never told them i was a celiac just think if i had"

"I had the same problem with BC/BS of Illinois.  I did obtain a letter from 
physician explaining that I was now in excellent health through my gluten free 
diet, and no longer even required iron supplementation (my presenting symptom 
was anemia).  I appealed the denial, submitting my doctor's letter along with 
my own letter explaining the diet and how it actually made me a better risk 
than individuals who eat an unhealthy diet and don't have regular check-ups.  
I was denied again.  BC/BS directed me to the State of Illinois program for 
people who are denied private coverage.

Fortunately for me, I changed jobs and was then able to be covered by my 
employer's plan."

"I also requested health insurance reimbursement for specialty foods due to 
celiac disease...I have harvard pilgrim hmo.  They denied me and told me 
that it had to be a malnutrition type disease such as Crohn's disease or 
something that requires you to be fed through a tube or such.  I called and 
spoke to someone after my submitted letter and denial and told them that it 
is a case of malnutrition in a sense because you lack the nutrients you are 
supposed to get due to intestinal damage.  Still, to no avail.
I don't get it.  I am pretty persistent when it is something I believe in 
and my food bill has gone up considerably because I am buying foods from 
health markets that I know will be safe for me."

I will be sending a part 2 with additional comments.  I hope that some of them 
are helpful.

Barbara in SW Missouri



 
 

 

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