One of the fancier terms that health insurance companies use to justify denial of coverage is “pre-existing conditions.” If someone has a medical condition prior to signing up for insurance it is considered pre-existing, even if they didn’t know about it, and it will not be covered by the policy. New health insurance reforms are seeking to put an end to discrimination against people with pre-existing conditions, but the question still remains as to the definition of what these “conditions” are. Here are some examples of pre-existing conditions with an explanation for each.
What is a Pre-Existing Condition?
A pre-existing condition is loosely defined in the healthcare industry as a medical condition that has afflicted an individual before they apply for health insurance. There is a lot more to it in terms of insurance coverage of course, such as how long you have had the condition, what medications are needed, how much in-hospital care will be required to treat the condition and so on. The important thing to remember is that any chronic condition can be seen as a basis for a health insurance provider to deny you coverage.
Diabetes is a good example of a pre-existing condition for which health insurance providers typically try to deny coverage. Diabetics have problems regulating their blood sugar and thus are in constant need of daily blood tests and even injections of insulin to regulate blood sugar levels. Diabetes is almost always labeled as a pre-existing condition by insurers because most people spend years as “pre-diabetic,” where their bodies are becoming insulin-resistant but are asymptomatic. Even though the person had no clue, if that condition began prior to coverage, it is pre-existing.
Another type of pre-existing condition is something that is not necessarily chronic or a daily occurrence, but something that you have a history of. Patients who have had a heart attack in the past, for example, but are not taking any sort of daily medication for high blood pressure are still considered a liability to health insurance providers. This is especially true if there has been more than one previous occurrence. Because of this history you would be more likely to require medical attention in the future and that is something that insurers would prefer not to pay for.
Believe it or not, a person’s lifestyle can be considered a pre-existing condition. The biggest example of this is smoking. Smoking is widely believed to be detrimental to a person’s health and so it is frequently regarded as a pre-existing condition. Basically, a pre-existing condition is a blanket term that covers everything that may cost a health insurance provider more money in the long term. If you’re a motorcycle stunt racer you might have some difficulty getting coverage.
Because the term is fairly ambiguous, the definition of a pre-existing condition is completely up to the discretion of a particular insurance company. What is not ambiguous is the extra rates charged for individuals who have these conditions and that they are often judged as pre-existing and therefore not covered. This is changing due to new health reform regulations, but until 2014 Americans still have to deal with pre-existing condition rejections.