How does the “pre-existing conditions” law apply? (Ohio)

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Please forgive me if I’m a little jumbled. I’m kind of at the end of my rope here. Looking for health insurance is always the worst part of every year for me and it’s only getting worse.

As you can see from the title, I live in Ohio. I’m 26.

Upon reviewing my healthcare.gov options for 2021 coverage, I cannot afford any of the premiums, and none of the plans cover my medication (which I cannot afford without insurance, and is not eligible for any prescription discount programs), OR any of my care providers.

I do not qualify for medicare or medicaid. I cannot get health insurance through my employer and will not be able to change employers or get a second job any time in the foreseeable future.

There’s a company that has an individual plan in Ohio that looked awesome to me. I got quotes and I can actually afford the premiums.

However, I applied for coverage. Their application was not user-friendly at all, and wouldn’t let me input the correct types/dosages of medication. They denied me based on the application, believing that I had untreated stomach issues. When I submitted an appeal and explained the situation, they denied me again because, and I quote:

“Health coverage plans let members share the risk of needing medical care and the costs of that care. Our health guidelines … allow people with a similar level of risk to share the risk of needing future medical care. To qualify for this plan, each person must meet certain health and eligibility guidelines. People who have a higher risk of needing medical care in the future do not qualify, even though they may be generally healthy now.”

I’m pretty sure I just have IBS and am lactose intolerant. But because I have not been able to afford the expensive diagnostic procedures for these conditions on my crappy ACA insurance, I don’t have any official diagnosis, and I think that scares them.

The way I see it, they are denying me health insurance due to a pre-existing condition. All of the information I can find anywhere is that this is illegal except for “grandfathered” plans which had to start before sometime in 2010, and this plan is new as of 2020. I can’t figure out if this requirement applies to non-marketplace insurers, though.

I just don’t know what to do. I’m seconds away from sobbing as I write this.

So I guess my question is twofold:

1) Is what this company is doing illegal? Do I have recourse?

2) What in the world options do I have?

submitted by /u/lightonahill
[link] [comments]
Please forgive me if I’m a little jumbled. I’m kind of at the end of my rope here. Looking for health insurance is always the worst part of every year for me and it’s only getting worse. As you can see from the title, I live in Ohio. I’m 26. Upon reviewing my healthcare.gov options for 2021 coverage, I cannot afford any of the premiums, and none of the plans cover my medication (which I cannot afford without insurance, and is not eligible for any prescription discount programs), OR any of my care providers. I do not qualify for medicare or medicaid. I cannot get health insurance through my employer and will not be able to change employers or get a second job any time in the foreseeable future. There’s a company that has an individual plan in Ohio that looked awesome to me. I got quotes and I can actually afford the premiums. However, I applied for coverage. Their application was not user-friendly at all, and wouldn’t let me input the correct types/dosages of medication. They denied me based on the application, believing that I had untreated stomach issues. When I submitted an appeal and explained the situation, they denied me again because, and I quote: “Health coverage plans let members share the risk of needing medical care and the costs of that care. Our health guidelines … allow people with a similar level of risk to share the risk of needing future medical care. To qualify for this plan, each person must meet certain health and eligibility guidelines. People who have a higher risk of needing medical care in the future do not qualify, even though they may be generally healthy now.” I’m pretty sure I just have IBS and am lactose intolerant. But because I have not been able to afford the expensive diagnostic procedures for these conditions on my crappy ACA insurance, I don’t have any official diagnosis, and I think that scares them. The way I see it, they are denying me health insurance due to a pre-existing condition. All of the information I can find anywhere is that this is illegal except for “grandfathered” plans which had to start before sometime in 2010, and this plan is new as of 2020. I can’t figure out if this requirement applies to non-marketplace insurers, though. I just don’t know what to do. I’m seconds away from sobbing as I write this. ​ So I guess my question is twofold: 1) Is what this company is doing illegal? Do I have recourse? 2) What in the world options do I have?
submitted by /u/lightonahill [link] [comments]Read Morer/HealthInsurance

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