Can I Be Denied Health Insurance for a Preexisting Condition? - Gianelli & Morris Switch to ADA Accessible Theme
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Can I Be Denied Health Insurance for a Preexisting Condition?

Under federal law, a health insurance company cannot refuse to cover you or charge you more based on a pre-existing condition.  A “pre-existing condition” is a health problem you had before the date your new coverage starts.

The Affordable Care Act Prevents Denial for Pre-Existing Conditions

Historically, health insurance providers limited coverage for people with significant pre-existing conditions.  If someone was unlucky enough to be diagnosed with diabetes, cancer, or a debilitating knee or back injury, health insurance companies were likely to either exclude coverage for treatments of those ailments in the plan, charge policyholders significantly more for their policies, or deny health insurance entirely.

Thanks to the Patient Protection and Affordable Care Act, also called the Affordable Care Act (ACA) or “Obamacare,” health insurance companies are no longer allowed to deny health insurance coverage based on pre-existing conditions.  President Obama signed the ACA into law on March 23, 2010.  Among the ACA’s massive overhauls included the establishment of a marketplace for consumers to purchase health insurance, and restrictions on the limitations insurance companies were allowed to put in policies.

According to current law, all marketplace policies must cover treatment for pre-existing medical conditions.  More specifically:

  • No insurance plan can reject you based on conditions you had before your coverage started.
  • Insurance companies cannot charge you more or subject you to waiting periods based on pre-existing conditions.
  • Insurers cannot refuse to pay for essential health benefits for any pre-existing conditions.
  • Additionally, once you are enrolled, the plan cannot deny you coverage or raise your rates based solely on your health.

What Are Pre-Existing Conditions?

Pre-existing conditions are health problems you had before getting your insurance plan.  They can range from physical injuries to illnesses to psychological disorders.  Theoretically, they could include any condition that an insurance company might have to pay a healthcare provider to treat.

Common pre-existing conditions that used to affect coverage before the ACA include:

  • Cancer
  • Diabetes
  • HIV/AIDS
  • Cerebral Palsy
  • Epilepsy
  • Gender dysphoria
  • Hemophilia
  • Obesity
  • Paraplegia
  • Paralysis
  • Hepatitis C
  • Depression

If you are denied health insurance coverage based on a pre-existing condition, the insurance company is acting in violation of federal law.  Talk to an insurance law attorney about your options for coverage and compensation.

Certain “Grandfathered” Plans Can Deny Coverage for Pre-Existing Conditions

Policies in effect before the Affordable Care Act went into effect are not subject to the same limitations.  If you have an individual health insurance plan (the kind you purchase yourself, as opposed to the kind you get through your employer) that you purchased on or before March 23, 2010, then your plan is not controlled by all of the ACA protections.  Those plans do not need to provide coverage for pre-existing conditions.  If, for example, you already had a diagnosis for cancer when you purchased your individual plan in 2009, your insurer might not need to provide coverage for your cancer treatments now.

Get the Coverage You Are Owed With Help From Gianelli & Morris

If you are wrongfully denied insurance coverage, if your California insurance has been wrongly rejected, or if you have experienced bad faith conduct by an insurance company, call the insurance law attorneys Gianelli & Morris for a free consultation regarding your case.

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