Covered California and ACA related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the ACA and Covered California knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Need Health Insurance - Previously Denied

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Question: I never see a doctor but consider myself fairly healthy. My wife on the other hand takes really good care of herself and sees her doctor for regular maintenance. Over the past year she has had trouble getting her thyroid levels right, which gave her a bit of high blood pressure but her doctor says their ok now and the blood pressure also. She is 5 ft 3 in tall and weighs 172 pounds. She was declined by Blue Cross 18 months ago and now we want to try and add her on to my plan because she's not covered at all right now. We live in Shasta County, CA which means we can only to apply Blue Cross or Blue Shield. I guess no other companies operate out here.

Answer: Thanks for your question. You're right in that there is very limited coverage in your county due to its rural nature. I spoke to my underwriter at Blue Cross to see how they would handle your wife's application. As I thought they would want to see her height/weight ratio shift a little if she has been treated for elevated blood pressure. Her BMI (Body Mass Index) is approximately 31.5. They would want her to have a BMI of 29 or less which would make the ideal weight between 104 and 158 pounds. She would need to have maintained this weight for 6 months or more. Additionally her blood pressure would need to be well controlled and her medical records will need to reflect that. The thyroid issue is also a concern. Blue Cross advised that, ultimately, they would need to see her medical records in order to make a final determination. I would go forward with an application but also submit a letter from her doctor giving as much positive information about her health history as possible. It just might help. Sorry I couldn't give you a more definitive answer.

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