My brother was denied insurance on Friday for a preexisting condition.

The health care debate has been up close and personal for our family. My younger brother, lost his job about 8 months ago,, he found another, but there were no benefits involved. He applied for insurance independently.. and he has been denied.

For a preexisting condition:

Sleep Apnea.

They denied him insurance because he used a C PAP machine and has sleep apnea.

I could just cry.

For every bought out or low information protester at town halls.. this is reality. The insurance industry picks and chooses who gets insured if you lose your job. You better know, for the grace of God there go I or you.

Sleep Apnea of the love of GOD.. freaking sleep apnea

Let me edit this to add.. this was a history of sleep apnea.. He lost 80 lbs 2 years ago and no longer has it. He does not use the machines.. but still denied. All his other health signs are perfect.

we buy our health insurance ourselves are so f-in clueless I have no words for the depth of their stupidity.

Every time they make this argument I want to gag and scream at them that they are NUTS to think an individual can get a fair deal from these jokers.

and does not have anyone paying his way to get to them to talk to the congress people. Mike is real America, real hard working blue collar America, who puts in 8-10 hours and has no benefits.

who are rabid and frothing at the mouth with losing to PResident Obama.

They have it.. and want to deny it to hard working people like my brother Mike. I am so tired of stupid people

sorry your bro was denied health coverage from that company. Hopefully, he'll be able to get it somewhere and a good job!

Go figure.

I'm so very sorry about your brother. :hug:

is the poster child of what is wrong with the current health care system.. Thank you for the support.. I am afraid, now that he has been denied by this insurance company, he is in for the full monty from them all.

No matter what happens he will be denied because of 1 condition. It makes you afraid to go to the doctor to begin with, because if you get a diagnosis, ANY diagnosis, it might prevent you from getting lifesaving care in the future.

Whether he had to wait a month for care or not (not sure if that is not just an urban myth spread by the right) at least it would be care. As it is now, Mike has nothing, and your B I L, is in effect being denied care, to try and save his insurance for the catastrophic (which might be avoided if he could trust to get preventive care and not lose his insurance.

Some where some how, our stories need to be heard, we have as much right to be heard about the abuses of the insurance industry as the tea hats have to spread their fear 24/7

I have known completely healthy people turned down for the following reasons:

mild high blood pressure (a brother-in-law)

onset of osteoporosis (my sister; believe me, 85% of all women over 50 get this diagnosis)

an injured finger (a friend of mine, and I kid you not! She was really turned down because her finger was temporarily misaligned)



Sleep apnea actually sounds halfway serious compared to some of these things. Though it's not. Let me tell you something: people are starting to refuse treatment for high blood pressure or high cholesterol for exactly the reason that it could come back to cause them rejection if they should lose their insurance. It's criminal.

triggers the pre-existing clause. No?

He now longer has it.. He at one point weighed almost 260 lbs, and lost about 80 lbs about two years ago, and no longer uses the C-Pap or has sleep apnea.

How they can deny people for things like that is a crime.

My husband was sent for an EKG and his doctor decided his left ventricle showed enlargement and ordered a battery of tests ... including sleep apnea. When my husband showed up, reluctantly, for the overnight test, they laughed at him. He weighs about 140 and is not exactly a candidate. By this time, I advised him not to do the MRI (we were paying for this all out of pocket, because our deductible for the year had not been met) and to see a cardiologist instead. Turns out, before he saw a cardiologist, that the original internist did another EKG and his heart was fine. Were these tests necessary? Shouldn't he have consulted with a cardio specialist first before ordering a lot of expensive and possibly unnecessary tests? And now, does my husband have a heart problem on his record that might prevent him in the future from getting insurance should he lose his?

Your b-i-l did not deserve to be turned down over an old and no longer relevant condition. But they are doing this all over the friggin place to people.

If this one thing (no refusal for pre-existing conditions), and one thing only, gets done, I will consider health care reform to be successful.

Outside of that old diagnosis he is fine.. his numbers are great.. I am still in shock.. someone further down the line, said that sleep apnea diagnoses can cause you to lose your Drivers Licenses. It seems to me, that sleep apnea is the cause de jour locally, everyone is getting these sleep tests.

This is just crazy

And a lot of money is being made off the tests. Someone ought to follow the money and look into this.

My cardiologist (now my former cardiologist) prescribed the test for me. I just didn't make the appointment, because I knew it was ridiculous. I sleep with my mouth closed all night, flat on my back. I have no symptoms of sleep apnea. So why should I put myself through that?

If the sleep apnea clinic is in the same building with the MDs prescribing the test, I am suspicious of the profit motive. The same is true for other expensive testing.

It's like being denied auto insurance because you drive a car:)

- Maybe he could find something through one of them. I hope so.

The link > http://www.nahu.org/consumer/hrpguide.cfm

Our biggest worry now, is that once denied by one company the rest just fall in line and refuse to cover him.

http://www.healthinsurancefinders.com/healthinsurance/south-dakota/risk-pool.html

South Dakota Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
South Dakota Risk Pool

Insurance Regulation Establishing Risk Pool
South Dakota Legislation
Chapter 20:06:48

Funding

The South Dakota Risk Pool is funded by premium dollars collected from persons enrolled inte risk pool health plan. Additional funds comes from assessments of commercial insurance carriers, stop-loss, and reinsurance carriers. There are also funds provided from general state revenue and an initial start-up grant from CMS' risk pool grant program.

Plans Offered

Unlike other state high-risk pools the South Dakota Risk Pool only provides coverage to people who have lost their coverage involuntarily and have previous creditable coverage. The program does not provide health insurance coverage to uninsured individuals that are unable to obtain coverage from private insures, unless they have also recently lost creditable coverage. There is one medical insurance plan offered through the risk pool. The plan is a PPO plan with a variable of three different deductibles. Also available is a Health Savings Account Plan.

Plan Benefits

The SD Risk Pool PPO Plan offers a range of In-Network deductibles, including a $1,000, $3,000 and $10,000 deductible. For most in-patient covered medical expenses, the plan member is required to pay a 25% coinsurance. For most out-patient services, the health plan member is required to pay a 25% coinsurance. The maximum out-of-pocket limit, which includes the deductible, is $3,250 on the $1,000 deductible plan, $5250 on the $3,000 deductible plan and $12,250 on the $10,000 deductible plan.
The Health Savings Account plan has a $3,000 deductible. For most in-patient covered medical service, the risk pool member is required to pay a 25% coinsurance. For most out-patient services, the member is required to pay a 25% coinsurance. The maximum out-of-pocket limit, which includes the deductible, is $5,000.

South Dakota Risk Pool Plan Brochure

Maximum Benefit Limits

The lifetime maximum, per enrollee, is $1,000,000.

Eligibility

You must have had 12 months of continuous creditable coverage. Continuous coverage means that you have not had a break in coverage of 63 or more days
You must apply within 63 days of losing your prior coverage
You must have used up any COBRA or state continuation coverage for which you were eligible
You are not covered under a group health plan, Medicare, Medicaid, or any other form of health insurance
Your most recent coverage was not terminated for nonpayment of premium or fraud
You must be a resident of the state of South Dakota and be able to provide proof of residency
Enrollment Periods

You may enroll in the South Dakota Risk Pool at anytime. Coverage will be made effective on the first day of the month following the approval of your application. Once enrolled, you may only make changes to your plan selection during the open enrollment period, which occurs during the month of July each year.

Premium Payments

Premium rates for the South Dakota Risk Pool plans are based upon plan selection, age and whether or not you are a tobacco user.

Premium Calculations

The premium cap is 150 percent of the standard average health plan premium charged by the three carriers with the largest number of individual health plan benefit plans in the state of South Dakota for the preceding year.

Pre-Existing Condition Waiting Periods

Since proof of creditable coverage is required to enroll in the South Dakota Risk Pool, there is no waiting period for benefits on pre-existing medical conditions.

South Dakota Risk Pool Contact Information

South Dakota Risk Pool
C/O Bureau of Personnel
500 Capitol Avenue
Pierre, S.D. 57501
Phone: (605)773-3148

South Dakota Risk Pool Website

As are all those that work on his behalf. I hope he survives his being so. Me too. I am fighting on several fronts, that being just one. For very personal and survival reasons.

This is insane. Our side of the story is getting no press.. while the limbaughists, are making it up as they go.. and in the end, relegating my brother, you and millions of others to non coverage and a single illness away from bankruptcy..

I had insurance, I thought. They thought otherwise. Second time insurance used a trick to leave me in a condition to throw myself on the mercy of society. The other time hit and run. Now though, I do not qualify for any assistance, I had to lie, about my health to qualify for unemployment insurance, the ss dis told me to go die. God has allowed me some time in proper KICK ASS health. I will use it to change my society. Lets roll.

You are in my prayers.. Somehow, someway.. we have to get this mess turned around

I know someone else who has sleep apnea and the physician treating her warned her that having that on her health record could even have the possibility that her driver's license could be taken away.

It is hideous. And I feel bad for your brother. This is just one of millions of stories where you pay your insurance company for years for coverage... just don't get sick...

They could take away their drivers license?? Oh Lord

These are the sort of letters Obama reads. These are the sort of issues Howard Dean cites in public.
Get the word out name the Insurances company that denied coverage by name. Be thorough, be specific.

Only by citing specifics can we overcome the BS of generalities the right is throwing in our faces.

They cry "socialism!" We cite specific examples of what is wrong. Their shouting fades. Our specifics do not.

E-mail the White House. Call your Senators and Congressmen or women. E-Mail Keith Olbermann and Rachel Maddow. E-mail Fox News and see if they have the guts to tell the truth for once.

is to put a face on the reality. I am going to ask Mike, if he will write the President and identify himself. He is so despondent right now, he may not. He has completely lost faith in the system. I will give him a few days to let it sink in.

That's who insured me after I was previously rejected. Same with a friend of mine. It's gonna be expensive. If CRL will insure him, make sure he picks the plan with a higher deductible/copay ... the insurance will be less expensive that way.

I'm sorry and my thoughts go out to your family and especially your brother.

I don't know what I would do if I was ever denied insurance. I am a diabetic. It seems like those of us who are not in "perfect" health are considered liabilities and they want us to just die. These are the real death panels.

who are not letting other people debate at town halls..and Palin and her ilk.. Those are the true death panels. Insurance denied, is health care denied. If Mike got seriously ill, out side of going to the emergency room, he could die, because of lack of care of something preventable.

I am in the same spot as you. If we lost my husbands insurance, there is no way I would get covered again, being a cancer survivor

... and stroke, and heart disease, and it's just generally unpleasant. It's far more than just a bad night's sleep.

Some, like your brother, have obstructive apnea that can be virtually cured with weight loss (using the CPAP helps) and sometimes surgery to take care of what my friend called her "flappy bits." Others, like me, are just grateful to have the little machine whooshing in our faces all night, because it appears to be a neurological problem.

I'm grateful Blue Cross covers this for me -- grateful that I'm within 3 years of qualifying for Medicare -- and pissed off like hell that in this scheme of things if I lose Blue Cross I am uninsurable and so is Mr H.

I'm pissed off that your brother and millions of others are denied reasonable care.

I'm scared to death that if my son loses his job he will also be uninsurable, because he was just diagnosed with complex partial seizures. And I mean I am really, really scared.

:wtf: What the hell kind of system is this that just throws people away and doesn't care if they live or die?

Hekate

Virtually everyone has something that is pre-existing. The insurance companies are eager to insure the healthy 20 somethings, but people like my husband and I and your brother, are out of luck. It's immoral. My brother worked for big insurance for about a year. His job was to approve inpatient treatment for substance abuse issues (his specialty). They fired him because he wasn't denying enough treatment.

since he lost the insurance he had after being laid off. Got a new job with no insurance and very little wage--found insurance for low dollars but high deductible. When the insurance company found out he was taking cholesterol lowering medication, they raised his insurance and told him they wouldn't cover the medicine. So, now he doesn't take the medication and he canceled the bloated policy.

You know, they say driving is a privilege so they forced the public to buy auto insurance. California attempted to pass a law that every California driver would be minimally covered and those with assets could obtain additional coverage through private insurance. Some of the the gas tax would pay for the coverage. It was a bill for the working poor--for those who couldn't use public transportation to have a way to their meager paying jobs. The insurance greedy fekken corporations doled out millions to defeat it.

Now, we have a dilemma of health coverage--where reform has been attempted for well over sixty years. Same ole me, me, me greedy assholes stand in the way. To me, your health is not a privilege like driving, it is a right!!!! If the government forces us to be captured consumers to the insurance industry on this one-well, I won't be playing or paying. I trust the government more than I trust a for profit, greedy, unconscionable, unaccountable corporate monster.

I told my hubby years ago, the robber barons are back, stronger, greedier, sleazier and they've gone global.

:kick: