Pre-existing conditions?

Question

I was without health insurance from September 1, 2005 until July 31, 2006. Because I didn't have continuous creditable coverage, can my current health insurance deny me benefits for pre-existing health issues such as high blood pressure?

Answer 1

Under Federal law, insurance companies are required to provide coverage for pre-existing conditions ONLY if you meet HIPAA guidelines (with which it seems you are familiar, given your description.)

If you had longer than a 63-day lapse in coverage between creditable plans, YES, the insurance company can and will deny coverage for pre-existing conditions (for at least 12 months and sometimes as long as 24 months, depending on your state laws and the underwriting rules the insurance company has on file with the state.)

Assuming high blood pressure is your only pre-exising condition, you can expect to be rated up a little if it's well-controlled with medications. But they won't provide coverage for anything related to it during the waiting period. You might want to check with them, though -- some of them do still provide you with the same network discounts you'd get if it was a covered claim and some will also count the amount you pay out toward your annual deductible and maximum out of pocket for the year. (For instance, I know Anthem does this in Virginia.)

Answer 2

Since nobody regulates insurance companies, they can do whatever they want. They *could* deny benefits for high blood pressure, but since it's generally not super-expensive to treat (versus things like back pain, which at the very least requires physical therapy, or asthma, which if uncontrolled could be VERY expensive to treat - with various medications and in bad case senario - hospitalizations with oxygen treatments, etc - THAT costs an arm and a leg!) they probably won't deny it. If they do, negotiate with the doctor to not have to pay full cash price for visits.

Answer 3

generally if you get into a group insurance because of new employment, the insurance co can only limit coverage for pre existing problems for the first 6 months

Answer 4

Each state has a Department of Insurance that does regulate the Insurance Companies that do business in that state.

Trust me .. Insurance is HIGHLY regulated.

Answer 5

Usually they will deny payment for preexisting conditions for a specific period of time - 1 to 5 years.

Answer 6

high blood pressure, probably not, back injury on the other hand definitely .

Answer 7

Yes.

Answer 8

you might have higher premiums, but insurance companies can deny anything they want. that's what sucks.