Denial of Application for Policy

[free9man]

My question involves insurance law for the state of: GA

I applied for coverage from Blue Cross/Blue Shield of GA after my COBRA coverage ran out. Went through the whole application process, including getting them my most recent cholesterol numbers. I then got a letter stating that my application was denied because of my cholesterol. I know that having a denial of coverage is a huge red flag for my future, so I want to appeal the decision.

I called BCBG and inquired as to how to go about appealing. The person I spoke to said to get a fresh lipid panel done, then write a letter stating why I disagree with their decision and include cholesterol numbers that are below what they were. He did not give any indication how much improvement, just any improvement.

I got the test done and now have the results. While there are improvements in all areas, 2 are still out of the normal range. I am dieting, exercising and taking medicine...not sure what else I can do to fix things. Doctor is thinking about changing my meds. On my current short-term plan, that will cost me a bundle.

Any hints or tricks from any health insurance gurus on how I can work my appeal to have the best chance of winning?

Also, if I win my appeal...do I still have to answer that I have been denied coverage if I have to apply for new insurance someday?

[cbg]

My experience is almost entirely with group health insurance which has different rules than individual; also my state is a guaranteed issue state (which GA is not) which also makes a difference. So I'm not sure how much help I can be.

But I do remember some 20 years or so ago when we had someone rated as a smoker for a short term disability policy due to high nicotine levels. He had quit smoking two years before but was still chewing nicotine gum, which caused the problem. We told him to switch to Doublemint for 30 days; he passed the second test.

How long after the first test was the second one done?

[free9man]

It was several months. Don't have the exact dates in front of me.

[cbg]

Wish I could be of more help but my experience is just in the wrong areas for your situations. I'm out of ideas. If I think of anything, I'll let you know. Sorry.

[Betty3]

I was a life & health ins. underwriter (though did more life than health). You need to send the new test results to the ins. co. for review to see if the change in readings will be good enough to
change their decision.

There are no "tricks" to getting approved. Your "health" (lipid panel readings) must have improved enough to be approved.

Also, if I win my appeal...do I still have to answer that I have been denied coverage if I have to apply for new insurance someday?

Re this question, the company I worked for would expect you to answer yes, you were denied coverage in the past. You can add that you were denied coverage & later approved after sending in additional medical information or you were denied coverage on XX date by BC/BS but later approved by this company on XX date.

[free9man]

Just thought I'd update this thread real quick. My story has a happy ending. My appeal was accepted and my application approved. Thank goodness...quite a weight off the old worries.

[cbg]

Glad to hear it !

[Betty3]

That's great news!