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Health insurance -big problems!

Health insurance -big problems!

Old May 29th 2012, 10:05 pm
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Default Health insurance -big problems!

Wife not working and I'm self employed in CA. I don't qualify for group insurance but this forum recommended a local chamber of commerce or something like the IGDA. So that's what I did - and we, the parents, been denied coverage! (We do have temporary, emergency cover)

Allegedly joining something like the IGDA would give group rates and cover pre-existing conditions (see http://britishexpats.com/forum/showp...2&postcount=34 for example). I can't comment on the former but the latter is apparently NOT covered - yes it's group coverage, but not employer-based group coverage, and doesn't cover pre-existing. I'm not blaming the posters here: up until now Association Pros, who handle the IGDA insurance, never said there would be these problems.

Meanwhile the kids have been approved because legally they're not allowed to be denied coverage. But there is no limit on the rates, so DS (4-year old) is $460 per month and DD (baby) is $920 per month. However, these ought to be lowerable by going to have a physical exam ASAP - something we had planned to do in anticipation of Blue Shield's response, but couldn't arrange until we knew what Blue Shield wanted from the exam, as the exams here are like menus of tests and things you can optionally include or exclude depending on who wants the results of the exam.

Another problem is we've not been resident for 6 months. So how are we supposed to get health insurance for the first 6 months, I asked. I don't know, was the answer. But she's going to look into it and get some inbound immigrant insurance better than what we've got already.

The final problem is my cataract surgery I had 9 months ago. They appear to be denying any coverage just on that one issue. I could manage with eyes being excluded but that doesn't appear to be an option. To be honest, it's all a bit confusing so that may not be the case after all.

Any ideas where we go from here appreciated!
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Old May 29th 2012, 10:22 pm
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Default Re: Health insurance -big problems!

I'm not familiar with all the insurance types out there...are you saying you and your wife were denied individual insurance policies?

Rene
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Old May 29th 2012, 10:38 pm
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Default Re: Health insurance -big problems!

Please check out this link for Healthy Families: http://www.healthyfamilies.ca.gov/HFProgram/Join.aspx. I'm not familiar with the program as I don't have any children myself. However, I do understand that you can at least have coverage for your children at a reasonable cost.

Check out this link for costs in your own county: http://www.healthyfamilies.ca.gov/Pl...ernardino.aspx

ETA: I don't remember your immigration situation, but if your children are U.S. citizens, then you can disregard the Immigration requirements.

Good luck, let us know how it works out.

Last edited by Moonshadow_Girl; May 29th 2012 at 10:42 pm. Reason: More info
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Old May 29th 2012, 10:48 pm
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Default Re: Health insurance -big problems!

I would really recommend finding an insurance broker who specializes in health coverage. HI is such a minefield that you really need a professional to help, and it doesn't cost you anything.
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Old May 29th 2012, 10:50 pm
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Default Re: Health insurance -big problems!

Originally Posted by GeoffM View Post

Another problem is we've not been resident for 6 months. So how are we supposed to get health insurance for the first 6 months, I asked. I don't know, was the answer. But she's going to look into it and get some inbound immigrant insurance better than what we've got already.
Blue Cross/Blue Shield of Oregon covered me from day 1 from the minute I stepped of the aircraft. In fact it was all arranged from the UK before we left. Are you dealing direct with the company or through an insurance broker who sells health insurance. We used an agent local to where we were moving to.
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Old May 29th 2012, 10:54 pm
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Default Re: Health insurance -big problems!

Originally Posted by GeoffM View Post
Wife not working and I'm self employed in CA. I don't qualify for group insurance but this forum recommended a local chamber of commerce or something like the IGDA. So that's what I did - and we, the parents, been denied coverage! (We do have temporary, emergency cover)

Allegedly joining something like the IGDA would give group rates and cover pre-existing conditions (see http://britishexpats.com/forum/showp...2&postcount=34 for example). I can't comment on the former but the latter is apparently NOT covered - yes it's group coverage, but not employer-based group coverage, and doesn't cover pre-existing. I'm not blaming the posters here: up until now Association Pros, who handle the IGDA insurance, never said there would be these problems.

Meanwhile the kids have been approved because legally they're not allowed to be denied coverage. But there is no limit on the rates, so DS (4-year old) is $460 per month and DD (baby) is $920 per month. However, these ought to be lowerable by going to have a physical exam ASAP - something we had planned to do in anticipation of Blue Shield's response, but couldn't arrange until we knew what Blue Shield wanted from the exam, as the exams here are like menus of tests and things you can optionally include or exclude depending on who wants the results of the exam.

Another problem is we've not been resident for 6 months. So how are we supposed to get health insurance for the first 6 months, I asked. I don't know, was the answer. But she's going to look into it and get some inbound immigrant insurance better than what we've got already.

The final problem is my cataract surgery I had 9 months ago. They appear to be denying any coverage just on that one issue. I could manage with eyes being excluded but that doesn't appear to be an option. To be honest, it's all a bit confusing so that may not be the case after all.

Any ideas where we go from here appreciated!
You could try ex-pat health insurance to get you covered until you sort yourself out. http://www.staysure.co.uk/overseas/travel-insurance (says over 50s but I think they'll cover anyone for cash )
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Old May 29th 2012, 11:06 pm
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Default Re: Health insurance -big problems!

Originally Posted by Noorah101 View Post
I'm not familiar with all the insurance types out there...are you saying you and your wife were denied individual insurance policies?

Rene
This time it was supposedly group insurance, not individual. But yes we were previously denied individual as well, but that was when I applied from the UK and wasn't able to fill in their forms completely (denied due to non-resident).

Originally Posted by Moonshadow_Girl View Post
Please check out this link for Healthy Families: http://www.healthyfamilies.ca.gov/HFProgram/Join.aspx. I'm not familiar with the program as I don't have any children myself. However, I do understand that you can at least have coverage for your children at a reasonable cost.

Check out this link for costs in your own county: http://www.healthyfamilies.ca.gov/Pl...ernardino.aspx

ETA: I don't remember your immigration situation, but if your children are U.S. citizens, then you can disregard the Immigration requirements.

Good luck, let us know how it works out.
Thanks, at first glance it's a bit confusing wrt to category A/B/C, and seems rather expensive, but I'll dig more.

Originally Posted by Nutmegger View Post
I would really recommend finding an insurance broker who specializes in health coverage. HI is such a minefield that you really need a professional to help, and it doesn't cost you anything.
That's probably a good idea as a broker sorted my car insurance without any of the hassles that are usually reported on here for car insurance.

Originally Posted by lansbury View Post
Blue Cross/Blue Shield of Oregon covered me from day 1 from the minute I stepped of the aircraft. In fact it was all arranged from the UK before we left. Are you dealing direct with the company or through an insurance broker who sells health insurance. We used an agent local to where we were moving to.
I guess it's an agent (Association Pros) but not a local one.

Originally Posted by markwm View Post
You could try ex-pat health insurance to get you covered until you sort yourself out. http://www.staysure.co.uk/overseas/travel-insurance (says over 50s but I think they'll cover anyone for cash )
Seems to want a UK address before it'll submit the form. I'm not sure it's any more than emergency cover anyway, same as what we already have.
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Old May 29th 2012, 11:17 pm
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Default Re: Health insurance -big problems!

Originally Posted by lansbury View Post
Blue Cross/Blue Shield of Oregon covered me from day 1 from the minute I stepped of the aircraft. In fact it was all arranged from the UK before we left. Are you dealing direct with the company or through an insurance broker who sells health insurance. We used an agent local to where we were moving to.
How did you find the agent, from a site list or a recommendation?
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Old May 29th 2012, 11:25 pm
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Default Re: Health insurance -big problems!

Originally Posted by guitarmaan View Post
How did you find the agent, from a site list or a recommendation?
The IGDA application referred me to Association Pros.

What I'd hate to do now is to fill in yet another 15 page application form then wait 2 weeks for it to be summarily denied - again. Repeat ad nauseum.
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Old May 29th 2012, 11:31 pm
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Default Re: Health insurance -big problems!

Originally Posted by GeoffM View Post
The IGDA application referred me to Association Pros.

What I'd hate to do now is to fill in yet another 15 page application form then wait 2 weeks for it to be summarily denied - again. Repeat ad nauseum.
Welcome to America!
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Old May 29th 2012, 11:31 pm
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Default Re: Health insurance -big problems!

If I remember correctly you are a Software Consultant. Have you formed a company/partnership for your work?

The reason I ask is that if you have a company and there are 2 or more of you in the company (you and wife maybe?) you many be able to apply for Group health insurance for your company.

I was told this by a Health Insurance Agent when hubby and I were looking for individual policies. We considered setting up a Partnership just to be able to apply for Group coverage in case our individual application failed. Having a Group policy helps with pre-conditions.

You need to get a Health Insurance agent as soon as possible. Not surprised that the work based groups did not cover pre-conditions - so few policies, apart from employment based policies, do.

Last edited by SanDiegogirl; May 29th 2012 at 11:33 pm. Reason: additional
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Old May 29th 2012, 11:33 pm
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Default Re: Health insurance -big problems!

Originally Posted by GeoffM View Post
Thanks, at first glance it's a bit confusing wrt to category A/B/C, and seems rather expensive, but I'll dig more.
Okay, I understand the table a bit better now. But my income exceeds the maximum so they don't qualify anyway.
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Old May 29th 2012, 11:33 pm
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Default Re: Health insurance -big problems!

Originally Posted by GeoffM View Post
Thanks, at first glance it's a bit confusing wrt to category A/B/C, and seems rather expensive, but I'll dig more
Please check the second link from my post, that's where you'll find the actual monthly costs, no more than $50 a month from the most expensive category, Category C.
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Old May 29th 2012, 11:36 pm
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Default Re: Health insurance -big problems!

Originally Posted by GeoffM View Post
Okay, I understand the table a bit better now. But my income exceeds the maximum so they don't qualify anyway.
Copied from their website:

What if my child doesn't qualify for Healthy Families? Is there other health coverage I can get?
  • If your income is below the limit for Healthy Families, you may qualify for no-cost Medi-Cal. You can let Healthy Families send your application to the county office near you to find out if you qualify for Medi-Cal.
  • If your income is above the limit for Healthy Families, there may be other programs you can use. Call 1-800-880-5305 for more information. The call is free.
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Old May 29th 2012, 11:39 pm
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Default Re: Health insurance -big problems!

Originally Posted by GeoffM View Post
Wife not working and I'm self employed in CA. I don't qualify for group insurance but this forum recommended a local chamber of commerce or something like the IGDA. So that's what I did - and we, the parents, been denied coverage! (We do have temporary, emergency cover)

Allegedly joining something like the IGDA would give group rates and cover pre-existing conditions (see http://britishexpats.com/forum/showp...2&postcount=34 for example). I can't comment on the former but the latter is apparently NOT covered - yes it's group coverage, but not employer-based group coverage, and doesn't cover pre-existing. I'm not blaming the posters here: up until now Association Pros, who handle the IGDA insurance, never said there would be these problems.

Meanwhile the kids have been approved because legally they're not allowed to be denied coverage. But there is no limit on the rates, so DS (4-year old) is $460 per month and DD (baby) is $920 per month. However, these ought to be lowerable by going to have a physical exam ASAP - something we had planned to do in anticipation of Blue Shield's response, but couldn't arrange until we knew what Blue Shield wanted from the exam, as the exams here are like menus of tests and things you can optionally include or exclude depending on who wants the results of the exam.

Another problem is we've not been resident for 6 months. So how are we supposed to get health insurance for the first 6 months, I asked. I don't know, was the answer. But she's going to look into it and get some inbound immigrant insurance better than what we've got already.

The final problem is my cataract surgery I had 9 months ago. They appear to be denying any coverage just on that one issue. I could manage with eyes being excluded but that doesn't appear to be an option. To be honest, it's all a bit confusing so that may not be the case after all.

Any ideas where we go from here appreciated!
Welcome to the USA. I read a post on here somewhere recently about someone who has lived in the US for years but is moving back to Britain after being quoted $30,000 for medical treatment, despite having insurance. I know someone personally who chose to spend $4000 on some scans rather than have his no-claims messed with.
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