Pre-existing Conditions

By Author: Norris Rios
Total Articles: 568
Comment this article

Insurance companies are never slow in protecting their own interests. Give them half a chance and they have taken action before you knew there was half a chance. The way it most often works is that insurers write a term into policies giving them the right to cancel the cover if they find any error or mistake in the paperwork. This may look perfectly reasonable. Insurers cannot know everything about you and so must rely on what you tell them. If there's a breakdown in communication, they should have the right to refuse a claim. Except, in most countries where insurance is written, this is limited to situations where the failure to submit the right paperwork is evidence of fraud or a deception. Most other countries prevent insurers from canceling for trivial reasons. Well, that's there and we are here.

In the US, insurers routinely cancel policies on any technicality they can find. This is used to save them from having to pay out on claims. Thus, they collect the premiums while the going is good, and then refuse to pay out. Not very fair, is it? Well, the area in which it's been most unfair is the pre-existing condition. ...
... You would be amazed if you knew the range of medical problems some insurers have decided are pre-existing and the failure to disclose means they will cancel. Of course, it then gets worse because once you are pitched out into the market, you are labeled as having a pre-existing condition and no new insurer will pick you up. As an example, suppose you have transplant surgery and all goes well. Then you fail to respond to a routine request for information. Now your paperwork is incomplete and the insurer cancels - it's bad news to have the continuing bills for the drugs to suppress rejection. Then you find no other insurer will cover you.

Well, now look out for the pre-existing condition insurance plans to help those who are considered uninsurable. This is not yet a comprehensive solution. That must wait for 2014 when the Affordable Care Act comes fully into force. But, as from July 2010, every state must offer this safety net. Twenty-seven states have developed their own plans and run the program with federal money. The Department of Heath and Human Services run the plans in the other states. To find your local plan search for PCIP.gov which has details of all the states. Unfortunately, you must be uninsured for six months. That means a gap between reliance on COBRA or other benefits. Then you need evidence insurers have refused you cover for a pre-existing condition. If necessary, ask insurers for a letter refusing you cover.

If you qualify, you can get an individual health insurance plan. There are differences in the amount of the deductible for the different plans. The state sites all have a comparative chart showing the difference between the plans on offer. It's therefore for you to decide how to deal with this situation. If you go through your state's high-risk pool or accept a health insurance quote from an insurer, you cannot transfer to the PCIP to save money. Can you pay your way for six months?