Why Pre-Existing Conditions Are Vital To Health Insurance

MotivationJanuary 12, 2018

Many people in the United States —especially the ones who are sick—often receive bad news. This is because health insurance providers often fail to cover the associated costs of pre-existing conditions that these people suffer from. In this article, we are trying to help you to avoid any additional charges resulting from the refusal of your medical needs by your health insurance provider.

Pre-Existing Conditions According to Health Insurance Companies

Insurance companies define a pre-existing condition as a medical problem which existed before the date the patient purchased a health insurance cover. They generally use a couple of definitions to identify conditions like these.

Insurance companies have an objective standard in which the definition of a pre-existing condition is defined as one for which medical advice or treatment has already been provided to the patient before he or she enrolled in a new health insurance plan. The companies also have a broader definition of pre-existing conditions which specify that their client may have sought treatment for symptoms that were present before enrolling for another health insurance plan.

Pre-existing conditions can include serious illnesses such as cancer, or non-life-threatening conditions such as a broken leg or addiction to prescription drugs. Pregnancy, however, despite being a pre-existing condition will receive coverage from the health insurance company regardless of whether the buyer has sought prior treatment.

Are Pre-Existing Conditions Easy To Understand?

Health insurance companies have taken into account many scenarios that can include changing jobs, switching insurance providers, and purchasing private health care insurance. They have therefore created different conditions for which they will not offer coverage. They have even stipulated a timeline for jobs which you may have held in the past that you will be eligible for treatment for a pre-existing condition unless you have had creditable coverage with your old employer with no breaks exceeding 63 days.

Health insurance providers will apply a number of stipulations in order to refuse treatment for pre-existing conditions. In some cases, they will even make it difficult for you to get health insurance coverage when you have a pre-existing condition. They may demand an experimental procedure to be conducted, which is expensive because they are not willing to bear the costs. Health insurance companies find it beneficial to refuse coverage for people with pre-existing conditions because of the expensive nature of experimental procedures.

What Are The Solutions For People With Pre-Existing Conditions

If you intend to purchase health insurance, try to understand the procedures and read the policy information thoroughly. If you are unable to find the details in the documents provided, contact your insurance provider and request for a comprehensive explanation of the policies regarding the coverage.

When seeking a treatment that is classified as experimental and denied by the insurance provider, you have the option of contacting them and appealing their decision. You can even take the legal recourse if your insurance provider denies your appeal. However, make this your last resort because the legal system is slow and can be detrimental to you if you’re dealing with a serious illness.

“In my opinion, our health care system has failed when a doctor fails to treat an illness that is treatable.” ― Kevin Alan Lee

Purchasing health insurance can be tricky. Therefore, you must make an attempt to understand the terms of the policy before you decide to settle on a health insurance provider.