Representing People With Denied Insurance Claims

Can my claim be denied if I have a pre-existing condition?

On Behalf of | Aug 4, 2022 | Insurance Disputes

Those of us with a chronic health condition depend on our health insurance to help make our treatment affordable. So, if you were denied health insurance coverage based on a condition you had before enrolling in your current health care plan you likely feel frustrated and discouraged. After all, the point of health insurance is to take care of our medical bills, including bills involving a pre-existing condition.

Pre-existing conditions and health insurance

A pre-existing condition is a health condition you had prior to enrolling in your current health insurance policy. Hypertension, diabetes and asthma are some common types of ailments that could constitute a pre-existing condition.

Before the enactment of the Affordable Care Act in 2010, insurers were allowed to deny claims made that were based on a pre-existing condition or charge higher rates for those who had a pre-existing condition. This was problematic for many who needed treatment for a pre-existing condition.

The enactment of the Affordable Care Act changed things. Now, your health insurance claim cannot be denied coverage just because you have a pre-existing condition. An exception exists for those who enrolled in their health care plans before 2010. These plans may contain a grandfather clause that allows them to deny a claim based on a pre-existing condition.

What about life insurance?

Life insurance, on the other hand, is a different story. Life insurers are not bound by the same laws as health insurers. Life insurers can charge you more if you have a pre-existing condition or deny you a policy altogether.

Your health insurance claim cannot be denied just because you have a pre-existing condition. If you find yourself in a position where you are facing a denied claim due to a pre-existing condition, you will want to make sure that you know your rights under your current health care plan so you can advocate for your interests.