Hello, my name is Tara Rose, and I am very very confused and not sure what we do now.

I currently have Cigna as health insurance I pay individually as I own my own business and sole employee.

I was attempting to add my husband and his two stepchildren to my account as he recently lost his health insurance and Cigna denied coverage for them. What do we do in this situation?

The reasons given is: he currently has ADHD (a pre existing condition) and will require Ritalin medication, as well as we believe a wrong weight body mass index in addition to he injured his shoulder and because of this transition, we were not able to follow up.

His daughter was denied because of sinus issues,frequent migraines (again pre existing condition), she currently smokes although she is trying to quit.

The other daughter was technically approved but we need coverage for everyone. So we are now in a situation where we got denied, it is past open enrollment, we have no idea where to go from here.

We tried to be proactive and get this going, we were honest as we didn’t want something to come up, it was our understanding pre existing conditions would not be a problem, that is why my husband had been denied before. can you please direct us on what to do? We live in Colorado


Answer

If you get denied coverage due to preexisting conditions then: your insurer is breaking the law, you have limited coverage, or a grandfathered plan purchased before March 23, 2010.

You can appeal any insurance denial, but since you aren't looking for new coverage (and instead are trying to add family members to a current plan), the simple answer is that your plan most likely is a grandfathered plan from before 2010 when the preexisting conditions clause went into effect.

The easiest fix will be to get a new plan. Since it is outside of open enrollment, you'll need to look into your special enrollment options.

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