HEALTH INSURANCE EXPERT FORUM
denial of coverage

denial of coverage

I have been declined for medical insurance due to my liver enzymes being high. SGOT 41 and SGBT 55. I have gained weight and stopped exercising since 2008 and now have resumed reclaiming my life , but have dealt this blow with insurance coverage. I have already gotten Dr orders to resume the tests and he suspects fatty liver. Is this a serious condition to be declined coverage?. They have given me a chance to fight it by submitting a letter by my MD explaining the high level......everybody I talk to are in awe that they have declined me for such borderline levels, unless they suspect something more serious behind it. If it  is fatty liver, is that serious? Do I have a case in requesting an appeal?...can someone shed me some light?. My Dr is not very talkative, I know, I will change, but right now, time is not on my side I I need to resolve this....
Thank you for any suggestions or info.... Lili
Tags: denial
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Dear Lili,

In my experience health insurance underwriters (people who decide whether to insure you or not), are more inclined to decline a borderline case with no clear line of treatment than a fully diagnosed case even if the fully diagnosed applicant is required to take some treatment. The reason for this is that an underwriter is tasked with forecasting the risk which is more difficult in case of borderline cases. Having said that I believe it is worth the try & you should ask your doctor to help you answer any questions the underwriter has.

Sincerely,

Amir Mostafaie  
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