ConsumerWatch: Despite Health Reform, Young Adults Not Always Covered

(CBS 5) — When Health Care Reform passed last year, millions of parents with uninsured dependents were relieved. But not all dependents will have coverage right away.

When Evan Spinrod’s daughter turned 19, she was kicked off her family’s Kaiser’s health plan. Spinrod said that’s when he decided to buy her an individual health plan. But when reform went into effect, Spinrod was hoping Kaiser would take her back. “One it would be a savings, and two it would be a better plan,” he said.

But that’s when Kaiser diagnosed his daughter with cervical cancer. As a result, Kaiser denied the Spinrod’s request citing a pre-existing condition.

“One of the reasons why we have a health insurance crisis in the country is that insurance companies got very tough on pre-existing conditions in the last 10 years,” said Amy Bach, Executive Director of United Policyholders.

According to Bach, adding a dependent over the age of 19 with a pre-existing condition may depend on the type of coverage a family has.

“A private insurance company that’s selling individual not group policies could still reject a 19 to 26-year-old kid if they have a severe pre-existing condition,” she said. In this case, Spinrod has an individual policy, not provided through an employer which allows Kaiser to get around the Health Care Reform clause that prevents them from denying kids with a pre-existing condition.

“It’s frustrating because I can’t fight them by myself,” Spinrod said.

Even more frustrating is that his daughter was misdiagnosed by Kaiser and doesn’t have cancer after all. Kaiser tells ConsumerWatch she can now reapply for the health plan. Still Spinrod said that doesn’t close the healthcare loophole. “There are a lot of people like me who are going through this,” he said.

Starting in 2014, all insurance companies will have to except dependents even if they have a pre-existing condition. According to insurance experts, families who are looking for health coverage may be able to quality through Medi-Cal or the Major Risk Medical Insurance Program.

(© 2011 CBS Broadcasting Inc. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.)

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  • Lidija Alvarez

    Sad storry. It is also sad that I, an American Citizen without insurance, with pre egsisting condition of Systemic Lupus, can not afford the insurance I could get accepting the fact, but doesn’t qualify for Medical or SSI because I can still walk and make just little over the norm with only my husband working. I don’t tempt God by faking it when I see a doctor, and I welcome the day with less pain. I got denied Medical because there was 400 some dollars more in my bank than allowed. 400.00 which were gone with the next bill I had to pay. I have been without insurance for over five years, paying at the clinics and pharmacy, as well as over the counter meds and herbs and vitamines,doing what I could to keep my organs from getting affected. One night in the hospital cost me 12000.00; yes twelve thousand dollars, plus the ambulance of 2000.00. Where in the world people pay that much for one night in the hospital without it being a surgery or something. I was just put on the heart monitor and got a shot, sendwich and a breakfast. They would have kept me because of high blood pressure they were causing by activating fybromyalgia with too tight cuffs. So, someone please tell me, how is anyone to start a new bussiness when they Dr. bills ove their heads. I tried to open my own service based company, but now that is down the drain because no attorney would take my case pro bonno or on contingency; I am just too small of a fish, I think. Thanks for at least making us aware of what is going on and helping the ones you can. Happy New Year. Sincerely, Lidija Alvarez

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