Denial due to a pre-existing medical condition

High Risk Pool Plan*

MICHIGAN             

The Michigan Department of Insurance can help Michigan residents with health insurance questions and concerns.  The address is Michigan Department of Insurance, P.O. Box 30220, Lansing, MI 48909, telephone (517) 373-0220.

Blue Cross Blue Shield is the alternative mechanism in Michigan to offer all residents health insurance.  They can however, place a waiting period for a pre-existing condition up to 6 months.  You can call Blue Cross at 1-800-637-2227. Consumer Services, The Office of Financial and Insurance Services, Toll Free (877)  999-6442.

MINNESOTA *

The Minnesota Department of Insurance can help Minnesota residents with health insurance questions and concerns.   The address is Minnesota Department of Commerce, 85 Seventh Place East, Suite 500, St. Paul, MN 55101-2198.   

Ø      Minnesota Comprehensive Health Association (MCHA) was established to offer policies of individual health insurance to Minnesota residents who have been turned down for health insurance by the private market, due to pre-existing health conditions.   A health insurance agent can provide the applicant with more detailed information about the high-risk pool.  

Ø      The URL for the high-risk pool is www.mchamn.com.  The MCHA can be contacted at P.O. Box 64566, St. Paul, MN  55164, telephone 800-531-6674 or 651-662-5290.

MISSISSIPPI *    

The Mississippi Department of Insurance can help Mississippi residents with health insurance questions and concerns.    Address is Mississippi Department of Insurance,  1001 Woolfolk State Office Building, 501 N. West St., Jackson, MS  39201, telephone (601) 359-3569 or (800) 562-2957.

For more information on Mississippi high risk pool (601) 362-0799.

MISSOURI*

The Missouri Department of Insurance can help Missouri residents with health insurance questions and concerns.    Their web site is http://insurance.mo.gov/.  

The Missouri Health Insurance Pool (MHIP) was created by the Missouri legislature to provide a health insurance option for Missouri residents that cannot obtain health insurance in the private market or can but it is too expensive and has premiums that exceed 300% of the standard risk rate.  The MHIP excludes persons that meet one of eight criteria.  Most of these criteria relate to the existence of other coverage. 

The only exclusion for a health condition is if a person is denied other health coverage due to substance or alcohol abuse or self-inflicted injury.   Obviously, uterine fibroids does not fall within this category.  Therefore, "yes" the MHIP is a health insurance alternative for any woman afflicted by uterine fibroids.  Due to the MHIP's premium costs, I encourage such applicants to seek health insurance coverage through the private market first but if unavailable, apply with the MHIP. 

I also encourage any applicant to review the criteria that must be met to qualify for the pre-existing condition exclusion waiver – involuntary termination or current premiums exceed 300% of the standard risk rate.  If an applicant is subject to the MHIP's pre-existing condition exclusion and is afflicted by a condition that meets the MHIP's "pre-existing" definition, the exclusion applies for one year only and only applies to the medical plan, not the drug plan.

MONTANA*

The Montana Department of Insurance can help Montana residents with health insurance questions.   Contact information is Montana Department of Insurance, 840 Helena Ave., Helena, MT  59601, 1-800-332-6148, website http://sao.state.mt.us/sao/insurance/index.html. 

Montana does not have a program specific to this health condition, uterine fibroids.  However, depending on the circumstances of the individual, she may qualify for Medicaid, or she may be able to obtain insurance through the Montana Comprehensive Health Association.   The Association may be contacted by Montana residents at  800-447-7828. 

In certain instances, people may be able to avoid the denial of benefits from an insurer on the basis of a pre-existing condition.  Making a determination requires the facts of the individual case. 

NEBRASKA*    

The Nebraska Department of Insurance can help Nebraska residents with health insurance questions.  The address is Nebraska Department of Insurance, Terminal Building,  941 "O" Street, Suite 400, Lincoln, NE 68508-3639.

For more information on the Nebraska High Risk Pool: Phone (402) 343-3574, (877) 348-4304, website www.nechip.com. 

NEVADA    

The Nevada Department of Insurance can help Nevada residents with health insurance questions.  The address is Nevada Department of Insurance, Carson City Office, 788 Fairview Drive, Suite 300, Carson City, Nevada   89701, (775) 687-4270.

NEW HAMPSHIRE*

The New Hampshire Department of Insurance can help New Hampshire residents with health insurance questions.  You can contact the New Hampshire Insurance Department: 21 South Fruit Street, Suite 14, Concord NH 03301  603.271.7973 | Fax 603.271.1406, website http://www.nh.gov/insurance/.

Health insurance in New Hampshire is defined in two ways: 

Ø      First, group health coverage is available if one is self employed, or employed by an employer who offers group coverage.  HIPAA (Health Insurance Portability and Accountability Act) Federal, allows a break of 63 days if a person is changing from one group health plan to another.   As long as coverage is in place before 63 days elapses, the new carrier cannot impose pre-existing conditions.  However, if an individual has gone longer than 63 days without group health coverage, pre-existing conditions can be imposed.   

Ø      New Hampshire enacted the New Hampshire Health Plan (High Risk Pool) in July 2002, and it works as follows.  With the passage of the High Risk Pool comes medical underwriting in the Individual marketplace.  Four carriers offer Individual coverage and if a consumer applies with one of them for coverage and is denied due to a pre-existing condition, that denial gains them eligibility into the High Risk Pool, albeit at a higher premium.  Phone 1-800-578-3272. 

Another subject to consider, is that of self funded plans which are designed by large employers and funded from their corporate proceeds. These plans are regulated by the Federal Government and not State government.  Self-funded plans may exclude any type of coverage according to the company.

January 23, 2007:  "The Hospital Access Plus program, which is supported by 24 hospitals in New Hampshire, is designed to give a 15% discount to patients who don't have any insurance coverage and have undergone a medically necessary service.  I don't know the medical details for the women in your group, but I would encourage them to contact their local hospital and discuss it with the Patient Financial Services representative to see if their situation qualifies. 

The web site URL is www.nhha.org.  We have a lot of information available about the hospitals in New Hampshire, including links to their financial assistance programs they offer."  - K.

NEW JERSEY    

The New Jersey Department of Insurance can help New Jersey residents with health insurance questions.  Address is Department of Banking and Insurance, P. O. Box 325, Trenton, NJ 08625-0325, (609) 292-5427. 

NEW MEXICO*     

The New Mexico Department of Insurance can help New Mexico residents with health insurance questions.   Address is New Mexico Department of Insurance,  P.E.R.A. Building, 1120 Paseo de Peralta, P.O. Box 1269, Santa Fe, NM 87504-1269, Phone: (505) 827-4601 or 1-800-947-4722.

There is the New Mexico Health Insurance Alliance (NMHIA), which was developed for people who have been denied coverage or the Blue Cross Blue Shield New Mexico Insurance Pool (NMMIP).

The website URL is www.nmhia.com, and the phone number to the Blue Cross/Blue Shield of New Mexico Insurance Pool is (505) 622-4711.