There are some health insurance companies that will take clients with lupus, or other pre-existing conditions, if certain conditions are met. However, they are the exception to the rule. Most of the time such individuals will need to get their health care coverage through a high risk pool organized by their state if they have lupus in their health insurance history.
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It’s important to note that pre-existing conditions like lupus are a focal point in the debate over whether or not health care is a fundamental right in America. On the one hand, consumer advocates put forth the position that it is patently unfair that individuals with pre-existing health conditions can be denied coverage.
On the other hand, insurance companies defend their decisions by claiming allowing pre-existing conditions to be covered would put them in danger of going out of business. This article simply seeks to inform you of what’s available.
Under what conditions will a client with lupus be accepted for health insurance?
As a general rule, an individual may have lupus and not even know it because he or she has not been to the doctor to have it diagnosed. Should such a person apply for a new health insurance policy, and the records supplied by his or her doctor do not contain any suggestion of a lupus diagnosis, the insurance company has no basis for rejecting an application. Without a verified diagnosis no pre-existing condition exists from the standpoint of the insurance company.
If you suspect you might have lupus, and you apply for a new health insurance policy before seeing a doctor for diagnosis, you may run into difficulty if a future diagnosis is made and you begin seeking regular treatment. The insurance company will notice your immediate and costly medical bills and may move to either drop your coverage or raise your health insurance premiums.
A second condition which would allow a lupus patient to receive health insurance comes by way of remission. In other words, according to the U.S. Department of Labor your application for new insurance may be rejected if you received diagnosis or treatment for a pre-existing condition in the six months prior to your application. By implication, if you had been in remission for more than six months it is conceivable your application could be accepted.
What should an individual with lupus do if rejected by a health insurance company?
If an individual with lupus is attempting to get health insurance from a specific company, a rejection will pretty much end the possibility of acquiring health insurance through that avenue. It will be up to the individual to contact other insurance companies. If it is possible to get health insurance through an employer, it would be wise to do so. The last step is to contact the state health department or insurance department and inquire about signing up under a government subsidized high risk pool.
Fortunately, a lupus patient with limited income will almost always qualify for Medicaid; those over the age of 55 will qualify for senior health insurance through Medicare. Both Medicaid and Medicare are government health insurance programs designed to provide insurance coverage for those who cannot afford it on their own. It may be that a high risk pool in a given state is subsidized by one of these two programs. So if you do not qualify for anything else you should at least attempt to get Medicaid coverage.
What is lupus and why is it such a big deal for insurance companies?
The Lupus Foundation describes lupus as an autoimmune disease in which the patient’s immune system does not recognize the difference between normal body tissue and foreign invaders like viruses and bacteria. Because no distinction is made, the immune system often creates antibodies that will turn around and attack certain tissues. Lupus can affect the joints, muscles, organs, or just about any other physiological system.
As a pre-existing condition, lupus is of concern to insurance companies because it can be very expensive to treat. Furthermore, it is a chronic condition that most patients suffer with throughout their lifetimes. Even though lupus is a disease that ebbs and flows, flare-ups can cause significant tissue damage which requires expensive treatments. This is why health insurance companies are very cautious about giving coverage to a lupus patient.
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