General Discussion
In reply to the discussion: This message was self-deleted by its author [View all]Nye Bevan
(25,406 posts)Any insurer selling individual health plans (whether on or off the exchange) in your county cannot discriminate based upon pre-existing conditions. (However, grandfathered plans that are not being sold anymore will not be offered to anyone, whether or not they are in good health). Here in CT we have an off-exchange policy which I bought because all of the exchange policies offered only very narrow networks which excluded most of our doctors. Approval was immediate and without any questions about health. (The off-exchange policies are not eligible for subsidies but are still guaranteed issue).
For example, if you go to Anthem.com and enter your zip code to browse individual health insurance policies, you will get check boxes to choose between "Marketplace" and "off-Marketplace" plans. The "off-Marketplace" plans are not in the ACA network but are still guaranteed issue.
As far as the drugs go, yes, this is frustrating, but you need to persevere. Have every doctor you can write a letter explaining why this drug is essential. Make copies of previous prescriptions to show that your wife has been using this drug for a long time. And send all of this documentation with a polite but insistent appeal that this drug be covered. If the appeal is turned down, immediately appeal to the next level. If you have already reached the top level, immediately file a complaint with your state's health insurance department. I have needed to do this a few times over the years here in CT and not once have I ever failed to eventually get coverage of whatever I wanted. The impression I get is that their business model is to routinely deny coverage secure in the knowledge that many people will just give up, but the persistent complainers who keep escalating their complaints eventually get what they want. In particular, going to the state insurance department always seems to suddenly make them take you much more seriously.