The medical conditions that health insurance companies don’t care about are usually those that are considered to be pre-existing. A condition that is pre-existing is one that has been present prior to you applying for health insurance. Many insurance companies will simply not insure you if you have these conditions.
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Even if you find a health insurance company that will give you an insurance policy, the condition that is pre-existing will probably be excluded from coverage. The result is that if you have any medical care or service performed for that condition your insurance company will not pay for the coverage- it will be outside your health insurance plan, and therefore completely your responsibility to pay for it.
What are some examples of pre-existing conditions?
Pre-existing conditions refers to a wide variety of conditions. Some of these conditions are health conditions that are long term and you have had for a long time. These include cancer, diabetes, asthma, high blood pressure, and heart disease.
For some companies, obesity is also considered to be a condition that is pre-existing. The term “pre-existing condition” can refer to any condition for which you have gotten treatment previously or are receiving treatment for currently.
Can a health insurance company deny coverage if you have a pre-existing condition?
If you have had or currently have a pre-existing medical condition, unfortunately you may be denied medical coverage by certain companies. HIPAA stands for the Health Insurance Portability and Accountability Act and it sets certain rules and regulations in regards to health information, medical records and privacy for consumers.
In 1996, HIPAA decided that health insurance companies can choose whether or not to cover conditions that are pre-existing. This means that if you have a pre-existing condition, you may have difficulty finding an insurance company who will accept your application. Having a coverage denial on your medical records can affect your health insurance coverage and can also negatively affect your acceptance with other carriers.
For those companies who accept you despite a pre-existing condition, they will often exclude your condition from health insurance coverage. This exclusion may last indefinitely or it may last for a particular amount of time.
As long as you have not received any treatment for that same condition, it will be covered after that time has passed. For more information about chronic conditions or serious illnesses and insurance coverage, you can visit the Insurance Information Institute.
Do pre-existing conditions exist for group health insurance plans?
One of the benefits of getting group health insurance coverage through your employer is that you cannot be denied coverage if you have a condition that is pre-existing. HIPAA helps protect those participants of group plans by limiting pre-existing conditions exclusions. For more information, visit the United States Department of Labor.
If you are an employee and are offered health benefits through your employer, it would be a very smart move on your part to take advantage of it. This is especially true if you have a condition that may not be covered by individual health plans.
Where can you find health insurance companies that offer coverage for pre-existing conditions?
There are not a lot of insurance companies that offer insurance for those with pre-existing conditions. The reason is because in the end these pre-existing conditions cost the insurance company a lot of money, especially if it is a comprehensive plan that is unlimited.
The insurance companies who offer insurance policies for those with pre-existing conditions usually offer insurance plans with limited plans. This means that medical services you receive for your pre-existing condition may be paid for, but only up to a set amount. Once that limit has been reached, you are responsible to pay the rest out of your own pocket.
Individuals with a pre-existing or chronic condition who do not qualify for other insurance policies must find a company who specializes in these types of policies. There are also companies that offer health plans for pre-existing conditions that are not compliant with HIPAA. With these companies, you will pay money but not get much of a benefit at all, so be aware of those types of companies. If you pay for health insurance, you want to make sure you get the benefits you are entitled to.
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