in need of some advice.

I haven't posted in a while but I was diagnosed back in November 05 and I also have APS and need to take coumadin. The past few years have been crazy, I've been to the ER four times, hospitalized, chemotherapy, bunch of medications, had myocarditis, pulmonary embolism, etc. The list really goes on but you get my drift..

But that is the least of my worries. I just turned 25 years old, and my mom was taking care of my health care cost every month while I paid for medications, doc visits, labwork. However.. I did not realize she was late on a payment and had let it lapse. By the time I found out, the grace period was already up and my medical insurance was terminated. I had no idea, because I had just gotten refills on medications and just had a visit with my doctor and my next appt wasn't for another three months.

Prior to all this, I was a member of Kaiser Permanente for over 10 years. And now they've kicked me to the curb. I've tried reapplying but of course I was denied. I don't know what my other options are. I'm in need of health care, but I know I will most likely be denied due to "pre-exisiting" conditions.

I'm going to try and reapply for a reassessment, and I have 30 days to obtain letters from all the doctors I've seen in the past to help my case. However, it's a long list of doctors, that includes my primary care physician, rheumatologist, dermatologist, neurologist, ophthalmologist, OBGYN, head neck surgeon, and optometrist. I've read people getting denied for things as little as abnormal pap smears. And I know that my reassessment is probably not going to do any good, even with the support of my doctors.

I'm not eligible for hipaa since my account was terminated for non payment. I don't know anything about cobra, but from what I've read, I don't think I'm eligible for that either. They said I can apply for the MIRIB Major Risk Medical Insurance plan for California. However, enrollment into that is not guaranteed either and they only accept a certain amount of people each year due to funding. The current wait list is about 300+ people.

I can't sleep, I can't eat, I'm scared. I'm going to run out of medications soon and I don't know what to do.

I'm trying to stay as calm as possible, but I'm not going to lie I'm scared. I get chemotherapy every six months and I'm about to reach that mark when I'll be needing it again soon and that's usually when my labs start going downhill.

With it being the weekend, there isn't much I can do right now. I've been reading up online, and trying to understand all these laws and jargon. But our healthcare system is such a mess.

The letter I received stated that if I want an reassessment, that I need to provide additional documentation supporting my request from a licensed health care provider familiar with my medical situation as well as a written letter from me. And just to be prepared to explain or correct any errors in my original application. And of course everything needs to be signed, dated, and post marked within the 30 day time frame.

I have a formal letter's written out to each of my doctors and will be dropping them off first thing Monday morning. I'm hoping that each one of them will cooperate and help write a letter of referral in my case.

I don't even know where to begin to look for an attorney. But that looks like something else I'll be spending today googling. I received the denial letter on the 10th. So my 30 days is already partly gone.

And yep, I'm not eligible for Cobra either since I wasn't under insurance through an employer.

Thank you, I'll try and call first thing tomorrow morning since they're not open today. To talk to a case worker to see what my options are and if they can help.

I have all my letters for my doctors and I'll be dropping them off Monday as well. Hopefully I'll get the support of my doctors and that can help my case in the appeal. Although I'm not holding my breath on it.

I'm just so frustrated, because of a late payment my insurance is canceled after being a member for over 10 years. There is nothing I can do. I can't renew my membership. My hopes of getting any other insurance is next to none. And there's nothing I can do.

So I went to go drop off the letters today and for the most part the receptionists were nice and said they would leave the letters with my doctors. However when I tried to leave one at my dermatologist's office, they said I couldn't. And they sent me to medical secretaries who said I could only request one letter from one doctor. So I only had to pick one. So I'd guess getting referral letters from each of my doctors isn't going to work. So I requested it from my rheumatologist. Hopefully I'll hear back from my doctor and see if she has any advice for me.

I also contacted the patient care advocates, and they said a case worker will call me back by Thursday at the latest to help me with my case. So I'm waiting to hear back from them to see what they have to say.

In the mean time I'd guess I'm just stuck waiting. I put in an application with my state's high risk insurance, but there's a current wait list. And I think the number is around 350ish people ahead of me on the list. And they estimate the wait is going to be at least 6 months to a year if not more.

So I've been trying to search for a new job that offers insurance that I can use. I'm going to try and call free clinics soon and see if I can see a doctor there.

Thanks for the advice..

I'm still going to try and appeal the denial, but even with my doctor saying that it probably isn't going to help. I'm not going to keep my hopes up on that.

Also, I haven't heard back from the case worker at the patient advocate's yet.

But what I did do is send in my application for the MRMIP program in California which is the Major Risk Medical Insurance Program which is guaranteed issued as long as you meet all the requirements. So I just have to wait to get approved by the state. The representative said the wait list number that they update weekly is a little misleading. Currently when I checked it said it was at 350. However enrollment is given on a first come first served basis and due to the space they have available. So some days if they have available spots open, say wait list person 4 and wait list person 50 could be enrolled on the same day. But either way, there still is a wait of at least 3-4 months.

So, it looks like I'll be getting my insurance back if not through Kaiser then I will definitely be able to get it through the state. However they have a rule to pre-existing conditions and there's an 3 month exclusion period after you've signed up and it's not covered until after that time frame. The only way I can get that exclusion waved is if I'm on the wait list for 6 months.

In the meantime, I'd guess I just have to wait it out. It does give me some peace of mind since they cannot reject me, I'm just keeping my fingers crossed for my health to be okay the next few months until then.

Also, since it's a State funded program. I can only stay on it for 36 months, after that they automatically dis-enroll you from the program. However, as long as you complete the 36 months, you'll be provided with a certificate of completion that would allow me to purchase individual coverage without any stipulations of pre-existing conditions.

That makes me feel a lot better knowing that at least I can get coverage eventually there's just a wait for it... wish me luck guys. And thank you again for all the advice that everyone's given me. I'll be sure to update as I find out anything.

Heidi--
Id still call back the patient advocate and say they didn't return your call, youmay have just gotten a forgetful worker or a new person. They use alot of volunteers but can be really good. I'd still hammer them because they may have even more help and a better solution even yet. Maybe weigh your options. I suppose they are swamped right now too. My experience was very positive. I'm glad you seem to have some recourse. I just think you ought to get your insurance back.

I really hope you can get the health care you need in the meantime. I know what it is like to have no insurance. I dread the day my husband has to change jobs because I will lose my health insurance. He is pretty much stuck where he is until he retires for my sake.