We received about a dozen stories from CCA members who have been denied insurance coverage, apparently because they have celiac disease. The stories covered life, group health and mortgage insurance. Most of the stories were about one particular company but most of the major companies were mentioned at least once.
Insurance companies like to control the amount of risk they take on. In this case, risk means the likelihood that they will have to pay a claim. Each company has it own “secret formula” that determines whether they will take on a particular client or charge that client more money for the same service. The process that determines the amount of risk is called underwriting.
For group health benefits, when a work group changes insurance providers all of the members are generally accepted without a problem, but if you have a higher than average salary or if you are joining the program late, you may be subject to underwriting and you may run into issues with coverage. Joining the program when you are first eligible may mean automatic acceptance, but if you want to join later, your celiac disease might become an issue.
If you are rejected, start with an appeal, pointing out that now that you are on a gluten-free diet and your celiac disease is controlled, significantly reducing the risks that come with untreated celiac disease. This may work, and it may not. You may be more likely to run into problems with life insurance, where each individual is reviewed separately. If you already have a policy in place with some sort of guarantee for renewal or rate protection, think seriously about potential problems before you give it up. If you are concerned about mortgage insurance, there is a difference between mortgage insurance and mortgage life insurance. If there is a life insurance component to the insurance you are seeking, you may run into problems.
Finally, remember that underwriting decisions are made on many aspects of your health and lifestyle. While it may appear you have been rejected because you have celiac disease, celiac disease may have been the final item that pushed you into the denial stage.
The bottom line is that if an insurance company turns you down, try another one. Many of the people who shared their stories with us did just that and had no problems with the second company they tried.