Misled by Insurance Comany

[fionnd]

What is the name of your state?What is the name of your state? Arizona
I own a small business and recently started the process of obtainaing health insurance for 3 employees. We are currently covered by cobra which expires end April. We were given a number of quotes and settled with Humana. I told the benfits consultant at the outset that my 7 year old daughter had Juvenile rheumatoid arthritis. I filled out an arthritis questionnaire with the application. I made it very clear that I did not want to go down any blind alleys and any coverage had to cover my daughter's condition. I was told in writing that the quote we were given and agreed to definitely covered previous existing conditions. My daughter has been well for two years with no medication and used to see a private rheumatologist as the only pediatric one in our town does not take insurance. Now the insurance Company has come back with a new premium over triple what they quoted fully aware of her condition. This is of course not affordable for us and three weeks before our Cobra expires we are facing the prospect of having no insurance. I am totally frustrated and desperate not to end up without coverage. Can the insurance company reneage on their quote like this. They have strung us along for 5 weeks. 5 weeks when I could have been looking at other options. I am not orgiginally from the U.S. and I find the insurance system completely overwhelming. Any advice would be greatly appreciated

 

[somarco]

Small group laws vary from state to state, so you really need an agent who is familiar with AZ laws to provide something definitive.

In general, HIPAA "guarantees" coverage without restriction to individuals who have had at least 18 months of continuous coverage with a prior carrier. It does not guarantee such coverage will be available at "standard" rates nor does it guarantee it will be affordable.

(This is what happens when legislators pass laws without fully understanding the repercussions of their decisions).

Your carrier is obligated to offer a quote and is entitled to tender an offer upon final review of all underwriting data. The agent you were working with should have explained this to you.

Depending on what small group laws say in your state, a carrier may modify their standard rates by a limited amount based on the deviation (from standard) of the risk in a particular group. In some states the most a carrier can raise rates is 2x . . . apparently it is 3x in your state.

Your current carrier probably has conversion coverage available for your daughter. You should investigate that possibility. There may be a high risk pool that will accept your daughter. That is another possibility.

The problem is not the carrier, but your daughters condition. Most individual plans will automatically reject an applicant that has a history of rheumatoid arthiritis.

Your only choices appear to be a conversion plan, high risk pool, or group coverage.

Another carrier might tender a better offer. If you go to another carrier consider a different agent as well. Seems this one has not treated you right.

You might also consider lesser benefits. My experience is that buyers tend to overestimate their insured needs and buy way too much coverage at a price that is impossible to justify.

 

[fionnd]

I will try the existing carrier tomorow. Also, the policy we were looking at was a group policy as we were going to purchase for the business. Currently there were two staff going up to 3 01 may. They were also told all of this. Its tragic that a little child should have to go without adequate medical care because of laws like this. I will also call some more agents.
Thank you for your help.

 

[somarco]

Your closing statement concerns me. No one is denying coverage to your daughter . . . in fact, as I pointed out, HIPAA precludes such an event.

You have options. Just not sure you have fully explored all of them. Now that you have more information you can look at other options.