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How do I appeal BCBS Application Denial

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Old 04-04-2007, 09:22 PM   #1
Join Date: Apr 2007
Location: Aurora, Il, USA
Posts: 1
chrisp1027 HB User
How do I appeal BCBS Application Denial

I need advise. I had BCBS of Illinois with my employer for 10 years. I was terminated in December 06 which left me without health insurance and I was not able to afford COBRA. I applied for individual insurance with BCBS of Illinois and I received a letter of denial from them. Their reason was that I was treated for depression. My question is can I appeal this? The reason I was treated for depression was because my daughter passed away. I am no longer on anti-depressants. How can I go about appealing this, I feel that if they knew the reason they might not have denied me. I am aware that Illinois has a program ICHIP that I am eligible for but I can't afford that.
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Old 04-05-2007, 08:06 AM   #2
Join Date: Aug 2006
Posts: 2
jjacksonesqpava HB User
Re: How do I appeal BCBS Application Denial

Unfortunatly, you may not be able to do so. You should ask BCBS IL if the have a process that allows you to appeal a denial of coverage.

Old 04-18-2007, 08:17 PM   #3
Join Date: Feb 2007
Location: Kentucky
Posts: 52
KyWildOne HB User
Re: How do I appeal BCBS Application Denial

Check with a local Insurance Broker that you can sit down and talk with. He or She will probably have a solution for you if not a Company that will issue you a policy.

I read your comment about the Cobra to be like every one else in the world, when you are termed from your job, you have little to no money, and spending it on Cobra is not always on the top of your list - more like your Mortgage and car payments and just month to month living expenses. SO I totally understood your choice in NOT getting it at that time.

I have advised many people to beg borrow and steal to remain on the Cobra policy, since yes, sometimes it is cheaper than any Individual policy out there. But more and more Cobra policies are being allowed to charge up to 110% of the price of the premium - and a lot of Companies out there pay the larger % for their employee. (the 10% is chalked up to adminstrative fees) so sometimes it can be just as expensive as an individual policy.

Good Luck
A lot of people approach risk as if it's the enemy when it's really fortune's accomplice.

Old 06-15-2007, 08:31 PM   #4
Senior Veteran
Join Date: May 2005
Posts: 520
t_411 HB Usert_411 HB Usert_411 HB User
Re: How do I appeal BCBS Application Denial

I was denied 2 times by BCBS because I was stressed and having anxiety over seeing my dad die slowly with lung cancer over a period of 4 yrs. I was treated with zoloft for about 1 yr and have been fine after I got over his death. Mental health will get you denied nearly every time with BCBS. HOWEVER, I did apply for humana health insurance as an individual, and was accepted but I ended up not taking it cause of getting married and covered via my hubby.
So screw bcbs if they screw you, just try and sign up with humana, or some other inc company. Humana has great programs very similar to BCBS programs.
(i'm not pushing or trying to sell anything, just offering advice based on my own personal experience).
Good luck!

Old 06-22-2007, 06:08 AM   #5
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Join Date: Jun 2005
Location: USA
Posts: 1,647
StenoLady1 HB UserStenoLady1 HB User
Re: How do I appeal BCBS Application Denial

I'm going through an appeal with BCBS over denying my application. I started my appeal on 5/9 and am still waiting to hear a response.

My rejection was over incomplete or inaccurate medical records, too. I physically brought them the "full" medical chart from my doctor, and my husband's doctor has amended one of his office notes that was made in error -- which I physically picked up and brought to BCBS.

I've talked to a broker about this. This has basically forced my hubby and I to use his employer's plan which is eating up most of DH's paycheck, because we don't want a lapse in coverage. Here in FL, it's 30 days, not 60 or 90. The broker says all the big insurance companies are notorious for doing this on individual policies. She said it helps the insurance industry as a whole to reject when possible. I've reached the point in time where it's going to be necessary to file a complaint with my state's insurance regulation office over this. BCBS assured me I'd have an answer within 21 business days -- from May 9th. It's June, what, 22nd now?

And COBRA here is a fortune! Here were our options:

COBRA at $872 a month for covering DH & I with a kick-butt good PPO plan from BCBS (we're mid-30s and a clean bill of health). Mind you, the employer that had this insurance paid most of it. It cost us $150 per month at the time DH was employed with this company before being laid off.

DH's new employer's BCBS HMO at $700 and change for the two of us. Really bad plan, IMO. I need a referral for everything, everyone needs to be in the "network," and anything medical needs to be preapproved by an adjuster. Scary;

Finally, the individual plan for DH & I through BCBS at $404 per month, PPO, decent plan, but nothing preexisting would be covered, no matter about a lapse in coverage or not. Preexisting is simply not covered for a two-year time period. After the two years are up and IF DH & I had not been treated for "the" condition, then we could reapply for a whole new policy to cover those things. We were rejected for this policy because of the paperwork screwup. Now I just want the appeal to go through and the rejection off our record.

Good luck with this. I wish I'd never called BCBS for a quote.

Last edited by StenoLady1; 06-22-2007 at 06:09 AM.

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