Group and Private Insurance

Those needing health insurance for individuals with pre existing conditions should be sure that they don’t take the first “no” as their final answer. They may pay more than they should if they take no for an answer or accept the first costly option. Not all insurance companies treat every condition and individual the same way.

An individual who believes that they have a pre existing health condition that will affect their ability to enroll in an insurance plan should first verify that their condition is a problem with all the plans available. Even if one or two medical insurance companies considers them a high risk or denies coverage, they should not assume that a second or third company will do the same.

Special Rules for Children with Pre Existing Conditions

Although there are certain conditions that adults will be denied for when they apply for any underwritten policy, this isn’t the case with children. The recent health care reform mandates changes this. As of September 23, 2010 (with few exceptions) a child who applies with a parent cannot be denied based on their medical history so long as one parent is approved for coverage. This is also the case when an individual applies through their place of business for a group health insurance policy with their child.

Adults with Pre Existing Medical Conditions

Health insurance companies do not all have the same underwriting guidelines. Each is a separate business and they will often assess the risk of insuring an individual differently. For this reason a person diagnosed by their provider with high blood pressure and high cholesterol, might be turned down based on their preexisting conditions when they apply for enrollment in a policy offered by one company. A second company may think that that person is a high risk, but approve their application but ask that they pay higher premium. A third company might not consider them a high risk at all and will approve that person for any of their plans with a standard premium.

Different companies will have different height and weight guidelines and therefore different opinions regarding whether an individual obese or whether they are just heavier than the average person and therefore will be willing to accept the risk of insuring that person. These differences apply to more serious preexisting conditions as well. Pre existing conditions like cancer, diabetes and heart conditions are treated differently by different insurance carriers.

You have to shop around not only for price and coverage, but also for the most favorable underwriting decision. Working with an agent who knows the health care insurance landscape in your area can go a long way towards making the experience of shopping around for health insurance less consuming and less of a hassle. An agent may be able to keep you from paying more than you should.

This is especially true when looking for private medical insurance for an individual with a pre existing conditions. Finding access to affordable health insurance means gaining affordable access to otherwise costly providers that can make a difference in the quality of your life.

There is a drawback to having a medical exam just before switching health care policies. You may be better off from an insurance perspective if you delay an exam until you have the new policy in place. Of course, you will need to weigh this risk against any risks to your health.  However, any new findings may be viewed as pre existing conditions and may prevent or delay your purchase of a new policy.

If you are considering buying a new medical insurance policy or are being forced to make a change due to circumstances, you may be tempted to get as much medical work done as you can under your old policy. This can make a lot of sense especially if you have already met the deductible on your current policy. You should probably get any work done on any conditions that you are already aware of before you apply for a new policy. If those conditions are resolved before you apply, you may actually get a lower rate or be more likely to qualify for the policy.

The problem comes when new health conditions are discovered just before you apply for a new policy. If it is a major condition, it can keep you from qualifying for an underwritten health insurance policy. If it is a minor condition it may not matter. However if it is somewhere in the middle, the new insurance company may want to wait until they know that the condition is stable before they will approve you for a policy.

The way that most insurance contracts are written, a pre-existing medical condition is one that you were aware of prior to the effective date of your policy. This means that a medical condition that you may have today will probably NOT be considered a pre-existing condition unless you have or have had symptoms that would cause a reasonable person to seek medical advice or you have had a medical professional tell you that you have that condition.

Should you get an exam just before buying a new health insurance policy and a new medical condition is discovered, it will probably be considered a pre-existing condition. This can mean that your new coverage will cost more. It can mean that your new coverage will not cover that condition. It can mean that you don’t qualify for a health insurance policy until the condition is resolved. It can mean that you are denied coverage and can never get coverage from a private insurer.

Even with a pre-existing condition you may or may not have options available to you from a government-based insurance policy. However, these plans are usually either expensive and/or very limited in benefits and/or require that you have a very limited income.

Waiting an extra month or so to have your exam performed after the new policy is in place is more advisable from an insurance underwriting perspective. However, this may not be the best medical advice.

On the one hand, getting medical care a month earlier could mean that an intervention saves your life. On the other hand if a condition is discovered, you may not be able to pay for your treatment if you don’t have the option of renewing your existing coverage. You may be denied any new coverage you may not be able to afford the long term treatment that saves your life.

This post is written from an insurance agent’s perspective. Delaying a medical exam can be risky from a health perspective. You will have to weigh the risks involved.  If decide to of play it safe from an insurance perspective and in so doing take a risk from a medical perspective.