No Longer Covered By The Parents Insurance

My wife and I own a small business in Florida, and we have to buy health insurance to cover our family. We have four children, two sons and two daughters. Our one daughter has some developmental and health problems. Because of those problems she will always need some help or guidance throughout her life. Because we have a child with special needs, our insurance premiums costs are very high. In fact, you could rent a one-bedroom apartment for less than we pay in monthly insurance premiums.

When summer started my son and his friends got an apartment together. He didn't go to college right away after high school. Instead, he took a year off to earn some money and will be starting college in January 2010. Only a few weeks after he moved out of our house, he became very ill and complained about serious pains in his side and stomach. When our family doctor examined our son, he sent us to a specialist for further examination. The specialist ran some tests and did some blood work hoping to find the problem, but he couldn't find anything wrong. He wants to run more tests. If he can't find anything at that time, he has another doctor he wants my son to see.

Because my son is 19 years old, the receptionist at each office wanted him to fill out the paperwork and give them his driver's license. When he moved into the apartment, he got a new license with his new address on it. The receptionists asked my son if he was currently a student or would he be going to school starting in August or September. He told them no, but he would be starting college in January.

All of the bills for the doctor visits and tests were submitted to the insurance company. Every claim was denied; it was unbelievable! I knew our son wasn't too old to be covered by our insurance policy. Right after he turned 19 he had an accident and ended up in the emergency room. All we paid then was the deductible. What made this claim different?

Apparently the difference is his status had changed. When we took him to the emergency room he still lived under our roof and we supported him. The issue isn't that he no longer lives with us but that he lives away from us and is not a student. In short, to be covered under our insurance policy if he is not going to school he has to be living in our home or he can have his own place and be enrolled in college with at least 12 credits a semester. Why didn't the insurance company tell us this requirement?

Right now we are responsible for about $3,000 in bills for office visits and various tests. My insurance agent said that once my son starts school again and we can show them a class schedule that proves he is taking 12 credits per semester, we can add him back on our health insurance policy. Until then if my son needs to see another doctor, we will have to pay all of the costs out of our pocket.