What is a pre-existing condition anyway?

I was reading in a health insurance plan that it is defined as: any condition where medical treatment or advice or diagnosis was given in the last 6 months.

What I don't get is say you sign up, and then you have a physical, and you tell the doctor about some pain you have been having, lets say for 6 months or longer, and they find out you have a health problem.

Will they say that is a pre-existing condition too? Or is that fine and then they will treat that individual with the insurance covering it.

"Where a medical treatment or advice or diagnosis was given in the last 6 months". Not that you had the pain for 6 months, but that you sought medical help (even just a diagnosis of the pain) and you have known about or been treated for a specific condition within the last 6 months. That is a "pre-existing condition" when you change insurance companies or get insurance.

EX: 1. I have a headache for 6 months, but don't see a doc about it. No pre-existing condition when I get insurance and then see a doc. Insurance will pay. 2. I have a headache and somewhere in the last 6 months I have seen a doc who diagnosed it (and did or did not give me medication). Then I get insurance and get further treatment for the headache. Insurance will not pay. Pre-existing condition.

I think you are right about that. Now I was thinking about this the other day. Lets say some guy or gal did get medical diagnosis in the last 6 months and the insurance says they will not cover it.

Ok, now lets say if they don't get treatment right away they might die because it is a serious condition. What happens then?

Also, another question I was wondering, a somewhat similiar question but also different, what if someone who had no insurance goes into the emergency room and they have a serious illness like cancer or something. Do the hospitals have to treat them or are they screwed?

Part 2: Sort of. It depends on the illness. Mental issues, for examples, are completely ignorable, and depending on teh city, you may find yourself "dumped" somewhere with your hospital id still on your wrist. (Google it.) If its cancer, then you can get into an "emergency fund" (depending on the state); the problem comes when/if you are declared "cured" -- your follow up visits to your specialists are not covered, and too many people don't go because they can't afford it. That's what happened to our family friend Jenny; her cancer returned, but it was too late, and she died three weeks later.

:cry:

In other words, it's anything the insurance companies decide it is.

I've known people who were denied health insurance for stuff that had occurred decades before. One woman was denied because she'd had a seizer following a car accident. The accident and seizure occurred 20 years prior to her trying to get private health insurance. It did not cause any long term problems. But that's the reason the insurance company gave for denying her.

My sis-in-law was denied because she was overweight.

We all have the same pre-existing condition - we're all going to die. Insurance companies just want people who are healthy and will live a long time and send them lots of money.

expensive and long term treatment. Let's say you are prescribed antibiotics for a strep throat. Ten years later you need an appendectomy. Your insurance will probably cover this operation, since it is a simple procedure with good prognosis. A couple years later you are diagnosed with some sort of lymphoma or a brain tumor and your insurance company calls the strep throat a pre-existing condition and denies your claim for coverage of treatment.

The above scenerio is hypothetical, but this is how the "pre-existing condition" scam works. Yeast infections and gall stones have been employed by insurance carriers as pre-existing conditions to deny claims to their clients.

who was diagnosed with breast cancer. Abuse of women is considered a pre-existing condition. As someone said, it's whatever the insurance company wants to define it as.

40+ years later. One company is dropping a policyholder for not being forthcoming about her "pre-existing condition" when she applied.

They deny coverage of seriously expensive illnesses and diseases that their clients contract later on, BECAUSE of the pre-existing condition. They use the pre-existing condition (acne, gall stones, whatever) to justify denial of claims of a later, more expensive, serious medical condition.

based upon the diagnosis codes. These claims are turned over to claims processors for special handling to look for reasons to deny payment. Many companies pay bonuses for claims processors with the highest rates of denials.

When it happened to me they wanted information on every doctor, every medical facility, every pharmacy that I had dealt with over the past 5 years. Then I had to sign releases for them to request all of my records from each of those providers. Then they contacted each of those providers for my medical records. I have no idea what they found to base their denial and when I appealed their denial, I was told I had no right to that information. I was irate because I knew there was absolutely NOTHING in my medical history to justify the denial.

I eventually had my claims paid but it took involvement of the state insurance commissioner, the state attorney general's office and an attorney.

They need to start sending the pigs who defraud sick people to jail. The lawsuits and fines do nothing. It's still much more profitable to cheat people out of the health care they promised to provide.

it's anything that an insurance company says it is.

the pre-existing condition is SEASONAL ALLERGIES. I was denied insurance.

in other words pretty much anything the illness and injury profiteers want it to be.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=385&topic_id=372871&mesg_id=372871

because he lost weight.. and he is still denied insurance.

so I was on hormone replacement therapy when I started a job with insurance. I had insurance but because I had a pre-existing condition I had to buy my own estrogen for the first year. After that they kicked down.

Fraud is the false charge, that they hide behind.

I used to think that it was a condition that you were diagnosed with and had had actively treated in the past six months.

However, my son was denied individual insurance recently. His crime? He had the audacity to have a brain tumor when he was 16. It was benign, removed, and he is now, six-plus years later, as healthy as anybody. The chances of recurrence are no more than the chances for the general population. He was also born with a moderate hearing loss in one ear.

For these crimes, he was unceremoniously denied insurance and told, that with this medical history, that he would never get an individual policy in Illinois.

His final mistake was wanting to live in Chicago. Some states have guaranteed issue laws. Unfortunately no state, except Massachusetts, has a guaranteed affordability law. Here in NJ, individual policies cost from $350 to THOUSANDS per month, but nobody can be denied based on history.

That's the wonder of states rights. Tough shit if you live in the wrong state. You just might not get insurance and then die because of it.

big bucks, they will scrutinize every record they can get their hands on that pertains to your medical history. If you so much as have a hangnail in you past, you're toast.

It could be something that you were completely unaware of and found out about it later. It could be something from your childhood.

Ultimately, it's just a contractual loophole which allows the insurance companies to keep your premiums without paying for your claim.

and yet Cigna still covers me. I have never been dropped...not when it was ConnectiCare either (his company, Yankee Gas, changed insurers). I don't get why I still am covered but others are not. This system makes no sense and therefore we need a federal law so everyone is treated the same way and no one gets denied insurance for a so called pre-existing condition.

In a group plan like you have, there are no pre-existing condition exclusions, at least for employees (I'm not sure about family members). Pre-existing conditions are mainly an issue for people buying individual insurance on their own.

fill out my medical history. But if he ever loses his job and we have to buy insurance...I am very afraid of that happening and getting rejected.

after the health care reform bill is passed. :-)

At the very least ban insurance companies from denying people care for pre-existing conditions.

If you look at your plan you have a prudent person clause that states that if you have a condition that a prudent person would go and have treated by a doctor it is a pre-existing condition. Pre-existing conditions could be anything as defined by the bean counters that work for your insurance company

they have the last word.

zalinda