In this thread (amongst others) it is mentioned that American insurers refuse coverage at all if you have pre-existing conditions. Here in the U.K., private insurers will cover you with specific exceptions for those pre-existing conditions. Why don’t American insurers do the same?
Many do.
Can you be more specific? What question didn’t get answered in that thread?
They don’t do it because they don’t have to do it. In cases where the law does require them to cover pre-existing conditions, they do.
I’m not asking them to cover pre-existing conditions; I’m noting that U.K. insurers simply exclude pre-existing conditions rather then refuse insurance and wondering why American insurers don’t do the same. According to Sir Prize, many do, though that jibes with what I’ve read here and elsewhere.
The US insurers can and have turned down insurance claims because of pre-existing conditions that had nothing to do with the claims being treated.
In general, if you have a pre-existing condition, many insurers will not issue insurance for you at all, and if they do, they won’t cover that particular condition for a year or two.
Oh, now I understand. Thanks.
I can offer several guesses, but I rather someone who KNOWS chime in.
It depends on the condition, which state you reside in, and the insurer. This typically applies to individual coverage, not employer provided insurance, so if your very large company provides you with health insurance you generally do not need to worry about this.
A handful of states restrict pre-existing condition exclusions to one degree or another. Some disallow an insurance company to deny you, but do allow them to charge you more to cover the increased risk your condition brings, although there is generally a limit to how much of a surcharge they can apply. Some states don’t allow you to take health status into consideration at all, like Maryland and their small group coverage, which results in what we call ‘community rating’.
Although it is much less common, sometime the insurer will insure you, but add a rider excluding coverage for any claim relating to your pre-ex, as mentioned above. IE if you come on the books with a broken leg, they will deny any claims you submit related to this condition. Companies typically try to avoid this type of coverage however, as it is much more complicated to administer, and really only possibly for minor conditions. If you have, say, diabetes when you sign up for coverage, which is excluded, and then suffer a heart attack three months later, who’s to say if that attack is related to your diabetes or not? I’m sure the insurer will argue it is the case, even if the doctors disagree.
Pre-ex denials for group coverage are also restricted if you have a history of certifiable insurance coverage, thanks to HIPAA. If you were without insurance for more than 63 days over the past 12-18 months before getting group insurance, the insurer can impose all the usual pre-ex conditions, although if you work for a larger employer it is generally not worth the administrative cost to investigate the health status of every one of your 1,000+ employees. Without insurance for less than 63 days, and your double lung transplant will still be covered, even if scheduled when you did not have insurance.
Anyway, to sum up, insurers will generally deny you coverage for most of the significant pre-ex conditions if state laws allow them to, simply because you will cost them more than you will pay them in premiums on average. Even if they can charge you more or add a rider instead, lots of times it’s more prudent to deny simply because your claims will have a much higher variance than a healthy person, and it is difficult to completely ‘rider out’ the condition.