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Covered California and Obamacare 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 Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Declined for Health Insurance

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Question: I was declined insurance and they said it was because of a previous claim that I made while I had employer coverage with the same insurance company. I called them to find out why and they said I was treated for high cholesterol while I had the group plan. I have never had high cholesterol, in fact I'm completely healthy!!! What do you think I should do about this?

Answer: This is more common than one might think. The problem, as you've described it, could possibly lie in the way the doctor coded the claim when they originally submitted it to the insurance carrier. To correct this you will need to find out the date of service and then go back to your doctor to ask them to resubmit the claim under the correct coding. You will also need to get a copy of your medical record related to the claim itself as well as a letter from your doctor stating that you have never been treated for elevated cholesterol. This is no easy task, however as not many doctor's offices are willing to go through this process for a patient. To save yourself the time and frustration I would make an application to an alternative insurance carrier.

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