# What is and isn't a "pre-existing condition" **URL:** \ **Category:** Great Debates\ **Created:** [May 9, 2017, 6:13pm UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210 "2017-05-09T18:13:49Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [May 10, 2017, 4:04am UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/21 "2017-05-10T04:04:36Z")
> [@Barack\_Obama](#): > > What is considered a pre-existing condition and how far does that term go? Is having a c section considered a pre-existing condition? Yes. > [@](#): > > Is depression considered a pre-existing condition? Yes. > [@](#): > > I’m confused on what is defined as a pre-existing condition. Will the states decide what falls under a pre-existing condition or is everything a pre-existing condition? If the insurance companies had their way yeah, pretty much anything would qualify as a pre-existing condition. Many states have passed legislation defining what can and can’t fall un pre-existing condition exclusions (one from California has already been mentioned). > [@Barack\_Obama](#): > > So if a women is sexually assaulted then that could lead to her having a pre-existing condition? Yes. And have. > [@](#): > > Is there no relief for certain circumstances where a condition is the fault of someone else? No. Why would there be? The insurance company is not your friend and doesn’t care how the condition came about. > [@elbows](#): > > How can irregular periods be a pre existing condition? If they are serious enough to have required consultation with a doctor then they’re a pre-existing medical condition ever afterward. > [@](#): > > Or having a C section? Sure. Any surgery and it’s possible consequences would be a pre-existing condition. > [@](#): > > So, 40 yrs later in life you have further problems, like uterine cancer, then what? Not covered due to pre existing irregular periods or a c section? Potentially, yes. That was certainly the way it used to work. > [@](#): > > Too bad, so sad? There goes the kids’s college fund, the retirement savings and guess you’ll have to sell the house? If that’s the case, it’s seems shockingly harsh! Welcome to reality in America. The insurance company doesn’t give a flying fuck if your kid’s college fund is drained, or your retirement savings raided, you lose your house, and you and yours are bankrupt. _The insurance company does not care_. They don’t care if you wind up sick and in a homeless shelter. > [@](#): > > That seems like craziness to me! As I said - welcome to reality in the US. > [@kenobi\_65](#): > > JOnce the OEP ends, most people can’t sign up for an ACA policy until the next OEP begins. However, there is a special, year-round “Special Enrollment Period” (SEP) for people who experience a “Qualifying Life Event” (QLE) – an event which potentially changes their need for insurance. > > The major QLEs are: > > - Getting married > - Having a baby (or other “changes in household size”; this also includes getting divorced, and no longer being under your former spouse’s insurance) > - Moving (since some people have health insurance which only considers local doctors and hospitals to be “in-network”) > - Change in job status (that is, losing your employer-provided health insurance when you leave a job, particularly if you start a new job where health insurance isn’t provided, or if you’re temporarily unemployed) > - Turning 26 years old (which makes you no longer eligible to be covered under your parents’ health insurance) You forgot “death of a family member” - when my husband died I lost my health insurance because it fell under a type of Medicaid and with just one person in the household my income was too high to qualify. So yeah, my husband died and then I lost my health insurance. That sucked. Fortunately (?!?!) death of a spouse is a QLE - I was able to get onto my employer’s insurance. ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [May 10, 2017, 5:40am UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/22 "2017-05-10T05:40:47Z")
> [@Broomstick](#): > > …Welcome to reality in America. > > The insurance company doesn’t give a flying fuck if your kid’s college fund is drained, or your retirement savings raided, you lose your house, and you and yours are bankrupt. _The insurance company does not care_. They don’t care if you wind up sick and in a homeless shelter… But let’s be clear, the fundamental problem with “reality in America” is not that private insurance companies are full of mean people and are not operating like charities. They are _supposed_ to be businesses run for profit. The problem lies 100% with incompetent US government healthcare policy. A government can either (a) make health insurance obligatory for everyone, regardless of state of health, so that the funding pool is adequate (this is what _every other developed country in the world_ does, one way or another). Or the government can (b) leave it up to individuals to find healthcare where they can, if and when they choose to. Under the latter approach, they _must_ allow private for-profit insurance companies to use _the same information that the buyer of the policy is privy to_ when assessing the expected liability from issuing an insurance policy, otherwise insurance is simply not a viable business. The fact that this fucks over anyone with a preexisting condition is the reason that _every other developed country in the world_ chooses option (a) as a matter of government policy. ---
**Author:** ![Lord\_Feldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lord_feldon/32/341_2.png) [@Lord\_Feldon](https://boards.straightdope.com/u/Lord_Feldon)\ **Post date:** [May 10, 2017, 5:49am UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/23 "2017-05-10T05:49:00Z")
> [@Velocity](#): > > This has long been a question of mine about the ACA - how it can possibly be fair for someone to be uninsured, break a leg, buy insurance, and \*then \*demand that insurance pay for the broken leg. It’s not all that fair if you look at this as a problem to be solved with insurance. But do people _want_ health insurance? It seems like what they want is care, not insurance. On basically every question, if you ask people how they want the system to work, they want it to look less like insurance and more like a universal benefit. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [May 10, 2017, 6:19am UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/24 "2017-05-10T06:19:34Z")
Exactly. The language of insurance screws up the discussion. UHC is a government benefit, just like police, fire, roads and schools. I don’t talk about my “police insurance” or my “firefighters insurance” or my kid’s “education insurance”. They’re all benefits provided by the government, funded out of tax revenue. Universal health care is just another government program. In our system (Canada), “pre-existing conditions” are irrelevant (except as needed by the doctor to understand the patient’s medical history). Although there are vestigial uses of the language of insurance, in practice medicare is another government benefit. ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [May 10, 2017, 6:35am UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/25 "2017-05-10T06:35:32Z")
> [@Northern\_Piper](#): > > …In our system (Canada), “pre-existing conditions” are irrelevant (except as needed by the doctor to understand the patient’s medical history). Although there are vestigial uses of the language of insurance, in practice medicare is another government benefit. In the U.K., nobody would have a clue what “pre-existing condition” even means as a phrase. Likewise (in the context of healthcare) “in-network”, “co-pay”, “deductible”, “pre-approval”. When you come from a country with a fairly sensibly-run universal healthcare system, it takes a long time to learn all the terminology used in the U.S., because it involves learning the screwy internal logic of a completely dysfunctional system. ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [May 10, 2017, 7:29am UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/26 "2017-05-10T07:29:19Z")
man, it’s so sad to read this stuff. Can’t imagine having to deal with this stuff when a loved one is involved. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [May 10, 2017, 9:25am UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/27 "2017-05-10T09:25:19Z")
> [@Riemann](#): > > In the U.K., nobody would have a clue what “pre-existing condition” even means as a phrase. Likewise (in the context of healthcare) “in-network”, “co-pay”, “deductible”, “pre-approval”. > > When you come from a country with a fairly sensibly-run universal healthcare system, it takes a long time to learn all the terminology used in the U.S., because it involves learning the screwy internal logic of a completely dysfunctional system. When we sign up new patients here (in Norway, private side) we have a section on the form for people to enter pre-existing conditions. Its so that we can be aware of them. Previous exposure to asbestos, drug allergies, diabetes, etc, etc… stuff we need to know about. We’ve not had an American fill in those forms so far, but anecdotally I hear from colleagues that the section can cause anything from a deer-in-the-headlights look to mild panic in Americans. ---
**Author:** ![igor\_frankensteen](https://avatars.discourse-cdn.com/v4/letter/i/839c29/32.png) [@igor\_frankensteen](https://boards.straightdope.com/u/igor_frankensteen)\ **Post date:** [May 10, 2017, 11:05am UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/28 "2017-05-10T11:05:40Z")
I don’t understand the confusion. ANYTHING can be “pre-existing.” All that “pre-existing” means, is that you had whatever it is before you tried to get “insurance” to pay for it. Having your car stolen can be a pre-existing condition. You can’t go to an auto-insurance company and get insurance on a car that’s already been stolen, and then get them to pay you for that. Simple way to think of it: look down the list of whatever the insurance company says they are willing to pay for. EVERYTHING ON THAT LIST WOULD BE CONSIDERED A PRE-EXISTING CONDITION IF YOU HAD IT AT THE TIME YOU SIGNED UP. Now. Most providers wont police the system strenuously for small things, but if you do put in for payments too quickly after signing up with many of them, you will have trouble getting paid. ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [May 10, 2017, 12:10pm UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/29 "2017-05-10T12:10:35Z")
> [@igor\_frankensteen](#): > > …Now. Most providers wont police the system strenuously for small things, but if you do put in for payments too quickly after signing up with many of them, you will have trouble getting paid. To be clear, under most policies right now (those that are ACA-compliant), you will _not_ have a problem with this, because pre-existing conditions are covered. The importance of the question lies in what _may_ happen if this administration eventually passes a healthcare bill. ---
**Author:** ![campp](https://avatars.discourse-cdn.com/v4/letter/c/c5a1d2/32.png) [@campp](https://boards.straightdope.com/u/campp)\ **Post date:** [May 10, 2017, 12:13pm UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/30 "2017-05-10T12:13:44Z")
> [@Weisshund](#): > > Dying is a pre-existing condition, it begins at birth. > I supposed someone would love to figure out how to play that angle They have. It’s called _Life Insurance_. 😉 ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [May 10, 2017, 12:17pm UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/31 "2017-05-10T12:17:27Z")
> [@Grim\_Render](#): > > When we sign up new patients here (in Norway, private side) we have a section on the form for people to enter pre-existing conditions. Its so that we can be aware of them. Previous exposure to asbestos, drug allergies, diabetes, etc, etc… stuff we need to know about… Yes, known as “medical history” in the U.S. Effectively, it refers to exactly the same information, but for the all-important context. Please tell me your _medical history_ so that we can give you the best possible medical care. Please tell me your _pre-existing conditions_ so that we can determine whether to withhold medical care altogether. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [May 10, 2017, 1:03pm UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/32 "2017-05-10T13:03:10Z")
> [@up\_the\_junction](#): > > man, it’s so sad to read this stuff. Can’t imagine having to deal with this stuff when a loved one is involved. It certainly does add to the stress and burden during a serious illness or injury. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [May 10, 2017, 1:04pm UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/33 "2017-05-10T13:04:44Z")
> [@Grim\_Render](#): > > We’ve not had an American fill in those forms so far, but anecdotally I hear from colleagues that the section can cause anything from a deer-in-the-headlights look to mild panic in Americans. It can also lead to _lying_ in Americans desperate to hide a pre-existing condition for fear of being refused treatment. Which is no way to run a healthcare system, and could lead to serious omissions in filling forms such as what you folks use. ---
**Author:** ![DrCube](https://avatars.discourse-cdn.com/v4/letter/d/a3d4f5/32.png) [@DrCube](https://boards.straightdope.com/u/DrCube)\ **Post date:** [May 10, 2017, 1:57pm UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/34 "2017-05-10T13:57:22Z")
> [@igor\_frankensteen](#): > > Having your car stolen can be a pre-existing condition. You can’t go to an auto-insurance company and get insurance on a car that’s already been stolen, and then get them to pay you for that. The problem with this comparison is that it isn’t insurance and never has been. Going to the doctor is a _certainty_, not a “risk”. And yet most “insurance” covers it to some degree. The United States has always had “subsidized healthcare”, not insurance, ever since the first factories started offering it during the war to compensate workers under wage controls. The whole point was that “we’ll pay you in healthcare because we can’t pay you more in cash”. It was never about “pooling risk” or “'mitigating a catastrophe” or whatever insurance is actually used for. Going to the doctor, or the hospital, or having medical issues that need treatment aren’t unforeseen costs requiring risk management, they’re dead certainties that employers pay for as a benefit to their employees. The only question now is whether that subsidized healthcare will remain a treat for those who are employed in a particularly generous field of work, or whether we will extend that subsidy to all Americans. ---
**Author:** ![Anny\_Middon](https://avatars.discourse-cdn.com/v4/letter/a/bc79bd/32.png) [@Anny\_Middon](https://boards.straightdope.com/u/Anny_Middon)\ **Post date:** [May 10, 2017, 3:57pm UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/35 "2017-05-10T15:57:44Z")
I posted the following to Facebook a few days ago. It’s from [time.com/money](http://time.com/money) – I can look up the exact cite if anyone wants: > [@](#): > > But what counts as a pre-existing condition? While it depends on the insurer—they have the right to choose what counts as “pre-existing”—these ailments and conditions were universally used to deny people coverage, according to the Kaiser Family Foundation, a nonprofit focusing on health care research: > > AIDS/HIV; Alcohol or drug abuse with recent treatment; Alzheimer’s/dementia; Anorexia; Arthritis; Bulimia; Cancer; Cerebral palsy; Congestive heart failure; Coronary artery/heart disease, bypass surgery; Crohn’s disease; Diabetes; Epilepsy; Hemophilia; Hepatitis; Kidney disease, renal failure; Lupus; Mental disorders (including Anxiety, Bipolar Disorder, Depression, Obsessive Compulsive Disorder, Schizophrenia); Multiple sclerosis; Muscular dystrophy; Obesity; Organ transplant; Paraplegia; Paralysis; Parkinson’s disease; Pending surgery or hospitalization; Pneumocystic pneumonia; Pregnancy or expectant parent (includes men); Sleep apnea; Stroke; Transsexualism > > But Cynthia Cox, Kaiser’s associate director, notes that the above list is a conservative sampling of all of the issues and maladies that insurers could count as pre-existing conditions. " There are plenty of other conditions, even acne or high blood pressure, that could have gotten people denied from some insurers but accepted and charged a higher premium by other insurers" says Cox. > > Here are some examples of those other conditions that experts have noted could hike premiums: > > Acid Reflux; Acne; Asthma; C-Section; Celiac Disease; Heart burn; High cholesterol; Hysterectomy; Kidney Stones; Knee surgery; Lyme Disease; Migraines; Narcolepsy; Pacemaker; Postpartum depression; Seasonal Affective Disorder; Seizures; “Sexual deviation or disorder”; Ulcers I have arthritis and sleep apnea. I have a history of kidney stones and asthma. I am 63 years old, and I suspect that just about everyone my age has a condition that’s on or the other of the above lists. ---
**Author:** ![ISiddiqui](https://avatars.discourse-cdn.com/v4/letter/i/97f17d/32.png) [@ISiddiqui](https://boards.straightdope.com/u/ISiddiqui)\ **Post date:** [May 10, 2017, 4:22pm UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/36 "2017-05-10T16:22:53Z")
> [@elbows](#): > > How can irregular periods be a pre existing condition? > > Or having a C section? > > So, 40 yrs later in life you have further problems, like uterine cancer, then what? Not covered due to pre existing irregular periods or a c section? > > Too bad, so sad? There goes the kids’s college fund, the retirement savings and guess you’ll have to sell the house? If that’s the case, it’s seems shockingly harsh! > > That seems like craziness to me! The way pre-existing condition exclusions worked prior to the ACA is that they could refuse to cover you for any of that for the first 18 (IIRC) months of your health insurance coverage. But after that, they could not. So as long as you held onto insurance for those 40 years (or had minimum lapses with less than 63 days without coverage), then you’d be covered. But people just getting insurance after having a long period without would have to be potentially subject to pre-existing condition exclusions for things from decades earlier - at least for 18 months or so. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [May 10, 2017, 7:10pm UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/37 "2017-05-10T19:10:12Z")
When I first signed up for individual insurance there was a lag time between when you signed up and when you could use the insurance . That was to make sure I was not signing up to treat a pre-existing condition. Pre-existing conditions can not be insured against so insurance is not the right way to handle it. Before it all got so complicated older people who wanted health insurance could take a physical to have their level of risk assessed. ---
**Author:** ![Kent\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kent_clark/32/105_2.png) [@Kent\_Clark](https://boards.straightdope.com/u/Kent_Clark)\ **Post date:** [May 10, 2017, 9:15pm UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/38 "2017-05-10T21:15:41Z")
> [@ISiddiqui](#): > > The way pre-existing condition exclusions worked prior to the ACA is that they could refuse to cover you for any of that for the first 18 (IIRC) months of your health insurance coverage. But after that, they could not. So as long as you held onto insurance for those 40 years (or had minimum lapses with less than 63 days without coverage), then you’d be covered. But people just getting insurance after having a long period without would have to be potentially subject to pre-existing condition exclusions for things from decades earlier - at least for 18 months or so. Actually, I know a whole lot of people who had pre-existing conditions which the insurance companies considered too high-risk to write policies for at all. Diabetics, people with heart disease, people who had childhood cancers, etc. My daughter was unable to find an insurance company that would even give her a quote for a catastrophic coverage policy. My daughter had a classmate who had an unexplained illness at age 5, never had a recurrence, and couldn’t find health insurance, either. This was in Missouri. Different states had different rules, YMMV. ---
**Author:** ![ISiddiqui](https://avatars.discourse-cdn.com/v4/letter/i/97f17d/32.png) [@ISiddiqui](https://boards.straightdope.com/u/ISiddiqui)\ **Post date:** [May 11, 2017, 1:56am UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/39 "2017-05-11T01:56:29Z")
Well, yes, there was no requirement that insurance covered anyone. But that isn’t the same thing as pre-existing condition exclusions. Sent from my iPad using Tapatalk ---
**Author:** ![JZoidberg](https://avatars.discourse-cdn.com/v4/letter/j/e56c9b/32.png) [@JZoidberg](https://boards.straightdope.com/u/JZoidberg)\ **Post date:** [May 11, 2017, 4:50pm UTC](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210/40 "2017-05-11T16:50:10Z")
> [@Canadjun](#): > > You might find [this](http://www.theglobeandmail.com/life/health-and-fitness/health/canadian-insurance-industry-pens-rules-on-use-of-genetic-test-results/article33573054/) interesting. That is too far. I wonder how much this goes on CONUS. I sold insurance once upon a time and since we collected saliva for certain policies (150+ I believe) it is not impossible that genetic scrutiny was conducted under the guise of drug and critical illness testing Sent from my SM-N900V using Tapatalk [Previous page](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210.md?page=1) [Next page](https://boards.straightdope.com/t/what-is-and-isnt-a-pre-existing-condition/786210.md?page=3)