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What Happens If You Have A Pre-existing Condition For Health Insurance?

By Cathy Wilson Posted in Health Insurance News

Health insurance companies love pre-existing conditions because they can freely deny people coverage based on this. But what exactly is a pre-existing condition? A pre-existing condition is any medical condition that exist prior to obtaining or switching medical coverage. Pregnancy is considered a pre-existing condition, high blood pressure or and chronic and acute illnesses are considered pre-existing.

The point, the insurance companies say, is to discourage people from obtaining health insurance only when they are sick. Someone who has not carried health insurance but decides to buy it when they get diagnosed with lung cancer is the type of consumer the insurance companies are trying to discourage.

You Can Still Get Insurance

Not all hope is lost. Many insurance companies have a grace period. Insurance companies will perform what is called a look-back where they examine or look back at your medical claims for up to eighteen months prior to see if you have been treated for any chronic illnesses. They can either deny coverage for anything pertaining to that condition or they can refuse to give you health insurance. You can still get health insurance but there will typically be restrictions. Your best bet is to try and avoid gaps in coverage between insurance plans.

Exclusion Periods

If  you are able to get health insurance then you will be subjected to an exclusion period. With an exclusion period your health insurance company will deny coverage for anything pertaining to that medical condition for up to a year after you get the insurance. During this period insurance companies typically do everything they can to avoid paying for the pre-existing condition. Even visiting the doctor for the flu is subject to scrutiny by the insurance company.

Depending on the reason for the gap between your previous insurance and your current insurance, most insurance companies are willing to work with consumers. It might mean paying a higher deductible or co-pays.

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