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Health Insurance Claims: Do Pre-Conditions Affect Your Claim?

pre-existing conditions health insurance app

Pre-existing conditions have been the bane of individuals looking for health insurance coverage for decades. If an insurer found out that you were pregnant, were diagnosed with cancer or diabetes, or otherwise had some condition likely to result in future medical treatment, you could be left without any options for insurance coverage. Healthcare reforms over the past decade and a half have largely put a stop to insurance discrimination based on pre-existing conditions.

To understand your rights to coverage regardless of any pre-existing conditions, read on. For help obtaining health insurance coverage or benefits after your claim has been unreasonably or unfairly turned down, call a zealous California health insurance denial attorney for help recovering the benefits you are due.

Health Insurers May Not Deny Applications Based on Pre-Existing Conditions

A pre-existing condition refers to a condition that an applicant already suffered before entering into a new health care plan. Prior to the Affordable Care Act (ACA), health insurance providers were free to deny coverage to applicants based on pre-existing conditions. Now, federal and state law protects applicants with pre-existing conditions.

A health insurance company cannot deny health insurance because of a pre-existing condition. Under most policies, you cannot be subjected to limited benefits, higher premiums, or outright denied coverage because of pre-existing conditions. “Grandfathered” health plans–meaning policies purchased before the additional protections were added–may have fewer protections regarding pre-existing conditions. Your health plan must disclose whether it considers itself a grandfathered plan.

Health Insurers Cannot Deny Coverage Based on Pre-Existing Conditions

Not only are insurers prohibited from denying your application based on pre-existing conditions; they are also prohibited from denying you coverage based on your pre-existing condition. They cannot charge you more, deny you coverage, or deny benefits specific to that pre-existing condition. Once you are covered by your health insurance policy, they must provide benefits for all treatments otherwise covered, even if those treatments pertain to a pre-existing condition. As noted above, there are limited exceptions for “grandfathered” plans that predate the ACA.

Some states allow insurers to sell “short-term” health insurance plans, meant to last initially up to a year and up to three years at most. These short-term plans were exempt from some of the pre-existing condition protections. Short-term health insurance plans are not permitted in California.

Delayed Coverage for Pre-Existing Conditions

Many health plans that covered pre-existing conditions included an exclusion period for treatments pertaining to that preexisting condition. For the most part, those exclusion periods were rendered illegal per the ACA.

However, as discussed above, grandfathered plans lack some of the ACA’s protections and may still include an exclusion period of up to 12 months (or 18 months for a “late enrollee”). During that period, the policyholder will be covered for services unrelated to the pre-existing condition but may be denied benefits for treatments related to the pre-existing condition.

Call a Seasoned California Health Insurance Denial Law Firm Today to Get the Benefits You Are Due

If your health, disability, or life insurance claim was unreasonably denied, or if you have otherwise been subjected to insurance bad faith conduct, fight for the coverage you are owed with the help of the seasoned, dedicated Los Angeles insurance denial lawyers at Gianelli & Morris. Call for a free consultation at 213-489-1600.

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