Raising Women’s Voices

What to Expect When You’re “Pre-Existing”

Posted in Affordability, Health Disparities, Pre-existing conditions by raisingwomensvoices on April 9, 2009

Last month, insurance executives announced a willingness to stop charging higher premiums–or denying coverage altogether–for those with pre-existing conditions or other health problems. However, it was made clear that this practice would be dependent on Congress requiring everyone in the US to carry health insurance, which is still many months away. Karen Pollitz, project director at the Health Policy Institute at Georgetown University, laments, “Under the current system, the people who need insurance most can’t afford or can’t get coverage.”

In the meantime, the New York Times outlines some guidelines for what to do when you are already sick:

1) Keep your employer’s coverage (if possible). Under the Health Insurance Portability and Accountability Act (HIPAA), employers cannot charge more for your coverage if you have a pre-existing condition. Be aware that new employees may be denied coverage for treatment related to pre-existing conditions for up to 12 months. But if, under an alternative group plan,  you have had continuing coverage, this may be applied to the 12-month period. If you have had a gap of 63 days or more, you can be denied a full 18 months, after which you are entitled to full coverage.

2) Learn your state’s rules. Federal law mandates that each state offer an individual option that cannot deny anyone coverage, as many individual plans deny those with pre-existing conditions. Find out what’s available at your state at the National Association of Insurance Commissioners. Unfortunately, the government does not regulate premiums, and cost can be somewhat of a problem. You can appeal your denial from a cheaper individual policy with the help of a doctor.

3) Seek alternate group coverage. Small business owners may be able to receive insurance through the chamber of commerce. Or several small businesses may come together for group purchasing alliances.

4) Be aware that insurance companies can rescind coverage. If applying for individual coverage, companies can rescind based on your failure to provide accurate information. Especially if you wind up getting serious treatment, even citing treatment for a canker sore months prior to developing mouth cancer as evidence of a pre-existing condition. Be ready to appeal with your doctor if necessary.

5) Watch out for temporary coverage. Temporary coverage, anywhere from a few months to a year long, seems like a good alternative, especially for those out of school or between jobs. But if you become sick, you will likely have trouble renewing because you will then have a pre-existing condition.


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