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Do I even have a chance?
Aug 6, 2004

Hello,

I have been diagnosed with HIV in march this year. Before I did the blood test I got individual health insurance with Blue Cross in Colorado. So I did the test and received "the news" after insurance was activated. I had to do more tests and see different doctors after that. Insurance denied the claims coding them as "pending investigation for pre-existing condition". They never sent any requests to any of the doctors in connection with this investigation. I had to do it myself. I called all doctors offices' I have ever attended in the USA and asked them to fax records to my insurance. I also sent the letter to my insurance stating that I have been in the United States since 1992 and my HIV status was negative then. All immigrants had to take that test prior to securing immigrant visa. Otherwise I wouldn't be allowed to immigrate to the USA. All those medical records and my letter was received by insurace company at the end of may. Two months passed and still no results. I call my insurance every other week. Nothing. I know it wasn't a pre-existing condition because as I said above my first HIV test in 1992 was negative and my second HIV test in march this year was positive but it happened after my BCBS coverage was active. Do I even have a chance with this insurance company? Or with the absence of proof they will drop me as "a non-profit customer". Or they drag their feet on purpose hoping I would drop or die. What other options do I have in the state of Colorado? We don't have many "individual coverage" options here.

Thank you so much for your time and kindness.

SA

Response from Ms. Franzoi

Yes, I do think you have a chance to retain this coverage. Assuming all of your responses to the medical questions on your application were honest and your HIV status was not determined until after the coverage went into effect, BCBS does not have a reason to drop the coverage or deny the claims as a pre-existing condition. I suggest you contact the state insurance commission if you don't receive a response from BCBS with respect to your pending claims. BCBS has a legal obligation to tell you if they are denying your claims and the reasons why. There are specific time periods within which this must be done. These time periods should be outlined in your policy.



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