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Denial of Coverage


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#1 Snowbird

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Posted 31 January 2009 - 01:22 AM

Hey Lyn

By being 'labelled' it means they put that in your file, which can make it either extremely difficult or non-existent for someone to get more life insurance, or to get it at all if they didn't have it before.
Sending good wishes your way!

#2 Jeannie McClelland

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Posted 31 January 2009 - 04:17 AM

I got labeled~

The first thing it did was to make it extremely difficult to have people look past the fibromyalgia diagnosis. Those that had accepted it was a 'real' illness used it to explain everything (shortness of breath and GERD??) and those that didn't decided I was a real hypochondriac and please don't waste their time. Someone else mentioned a similar experience.

The second thing labeling did for me was make the insurance company look for every opportunity to dump me. When my husband's employer was bought out, the insurance cover was supposed to continue seamlessly. We even had the same ID number, albeit a different group number. Same company, though. Oh my~ Crash, bang, the wheels came off the cart. Everything kept coming back: Pre-existing condition, coverage denied. When I called them, they told me they had no evidence of 'continuous cover' (!!!!) so they could refuse to take me on. Believe me, at that point you could have added heart-failure to my list of ailments!

There's a happy ending to both stories. I found a 'center of excellence' who looked beyond the fibromyalgia diagnosis. And after several months of several calls a week, somebody at the insurance company finally got things straightened out. Bless my doctors, nobody even flinched when the bills came back denied.

Warm wishes,
Jeannie McClelland
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#3 Margaret

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Posted 31 January 2009 - 07:40 AM

Hi Snowbird ,

My kid sister got denied life insurance two weeks ago because she only weighs 120 pounds at 5' 9". She was suppose to weigh at least 125. They denied her life insurance because of that and wrongly assumed she was anorexic. She's mid 40's, on her own and just decided to get some life insurance. Now she can't unless she puts on 5-10 pounds, depending on the company. Totally ridiculous!!!

Take care, Everyone.
Margaret

#4 Jeannie McClelland

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Posted 31 January 2009 - 08:03 AM

Hi All,

I'm moving a couple of posts from "Fibromyalgia" to here if I can figure out how to do it. (Looks like I did!)

Denial of Coverage is a serious subject, whether it's Life Insurance or Medical Insurance, but I'd bet more than a few of us have had some "Say what?!" experiences.

I love Margaret's sister's story! Being on the chubby side myself, I'm not likely to experience that one personally. :lol:
Jeannie McClelland
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#5 Snowbird

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Posted 31 January 2009 - 09:17 AM

Margaret

Now I think I've heard it all. How pathetic can they get because someone is what they consider underweight -- it's getting to be scary, isn't it? :o :o :o :)
Sending good wishes your way!

#6 Shelley Ensz

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Posted 31 January 2009 - 10:25 AM

Hi Margaret,

Your sister could probably get the 5 pounds added even without gaining weight. If she schedules her weigh-in at 1:00pm, eats a full breakfast, a big lunch, drinks 4 large glasses of water right before the appointment (no potty stops!), wears a winter coat, scarf, gloves, and a few stones in her pocket, keeps her purse on her shoulder, wears her heaviest shoes (better yet, boots!) and socks.

I've done just about all of the above, except for stones in the pocket, and not even on purpose as I surely don't need any extra weight at all (very far from it).

She could try it at home, see what magic combination it would take to get the 5 pounds, and then set a weigh-in appointment.

My guess is she had an early morning appointment, after fasting, no fluids, and took off her jacket and shoes, etc. and it did not actually reflect her "real", healthy weight.
Warm Hugs,

Shelley Ensz
Founder and President
International Scleroderma Network (ISN)
Hotline and Donations: 1-800-564-7099

The most important thing in the world to know about scleroderma is sclero.org.

#7 Jeannie McClelland

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Posted 31 January 2009 - 10:54 AM

Hey, this might be the time for those big dangling earrings, super-chunky necklace, and the ever popular armful of bangles! A nice heavy leather belt with an enormous buckle and loads of silver conchos could be good too. My dad had a presentation buckle that must have weighed five pounds and I'd be more than willing to loan it.
Jeannie McClelland
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#8 canon

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Posted 31 January 2009 - 11:46 AM

Hi All,

WOW!! This is why doctors don't want to make that diagnosis which gives most of us peace of mind. A doctor recently informed me that an existing insurance company can obtain a doctors notes and if it mentions a disease especially something like scleroderma for a few months and the insurance company is not informed in a timely manner about it, they can drop you from your current insurance. I have not been able to get short term disability since I was started on placquenil. My friend not able to get short term disability for a year after seeing a rheumatologist.

With gentle thoughts,

Judy
A happy heart is good medicine.

#9 Margaret

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Posted 31 January 2009 - 02:42 PM

Hi ~

Shelley, you always make me laugh!!!

My kid sister has always been super skinny, usually 115-120. It's not that she diets all the time or is anorexic; it's her genes. I am the same way, only not THAT thin. My kid brother is 6'1" and weighs a whopping 150 pounds. On the other end of the family spectrum, I have a sister and brother who are considered overly obese. We all love each other and have a great time together!!! It is a shame, though, what the insurance industry can get away with these days.

Take care, Everyone.
Margaret

#10 Stef

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Posted 02 February 2009 - 04:30 AM

Hi All!

I agree. It is absolutely pathetic that insurance companies are able to be so "selective". Health insurance coverage is truly different from something like automobile insurance coverage. After all, it's not as though anyone has or had any control over whether or not an autoimmune disease occurs (vs. having much more control over something like an automobile accident, at least in most cases).

I personally feel "pre-existing condition" exclusions are the newest form of discrimination. Having an illness is difficult enough, let alone fighting with insurance companies for coverage!

Warm Wishes to All,
Stef

#11 debonair susie

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Posted 03 February 2009 - 09:17 AM

I'm sure this is exactly why my rheumatologist encouraged me to go on disability (with her very special help).
She knew that this would create a problem with insurance, so felt that with Disability/Medicare, it would make things much easier for me.
Special Hugs,

Susie Kraft
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#12 mando621

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Posted 04 February 2009 - 04:24 AM

I'm worried about this also.

I was seeing an opthamologist about my dry eyes and he wrote in my chart possible Sjogren's. When I applied for life insurance I had to get my doctor to write a statement that I wasn't diagnosed with Sjogren's. Then the life insurance company put a rider on my plan that states I can't have Sjogren's and get benefits. So... I'm not in any big hurry to get an official diagnosis of Sjogren's.

I wonder what will happen if I get a diagnosis of something other than fibromyalgia? I have an HMO and I'm seeing my primary care doctor today to work on getting the referral my GI doctor wants me to have to a specialist in GI at the university.

Mando.

#13 Jeannie McClelland

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Posted 04 February 2009 - 04:50 AM

Hi Mando,

It seems utterly ridiculous that we and our doctors are being forced to chose between good medical practice (charting everything, including diagnoses and referrals) and risking what medical coverage we may still have.

I'd cross my fingers, if I could, that sometime soon we'll actually implement sensible and humane health care legislation.

Warm hugs,
Jeannie McClelland
(Retired) ISN Director of Support Services
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