Pre existing condition denials increasing under health insurance « Health Insurance Advisory

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new healthcare reform lawThe new healthcare law, called the Patient Protection and Affordable Care Act (PPACA), represents comprehensive healthcare reform legislation signed into law on March 23, 2010. It contains numerous provisions designed to protect consumers and promote low cost medical insurance, including many new taxes to pay for the cost.

In this section of the site, you can also obtain the following information specific to your state: available medical insurance options, efforts to regulate medical insurance premiums, healthcare, the individual medical insurance marketplace and the new healthcare law.

Our objective is to help Americans make sense of the new healthcare law by explaining key provisions in plain English and assisting individuals, families and the self-employed in using this information to find and secure affordable medical insurance.

Pre existing condition denials increasing under health insurance

According to BestWire (October 12, 2010), a committee of the U.S. House of Representatives released the results of an investigation into the handling of pre-existing conditions by the country’s largest medical insurers — finding the major companies denied major medical insurance coverage for hundreds of thousands of people in the individual market in the past three years. That denial rate has increased rapidly, according to data from the Energy and Commerce Committee’s examination.

The four largest U.S. health insurers — Aetna Inc. Group, Humana Group, UnitedHealth Group, and WellPoint Health Networks Group — denied major medical insurance coverage to 651,000 people in 2007, 2008 and 2009, basing that determination on previous medical histories. Over that time, according to committee investigators, the number of denials rose from 172,400 in 2007 to 257,100 in 2009.

Basing some of the findings on internal company documents, the committee investigators said almost 15% of one of the companies’ individual major medical insurance market customers had riders on their policies to limit coverage or increase deductibles for care in areas in which they had prior medical issues. Executives in one company looked at “improved pre-existing exclusion processes” as a means for strategic growth. Among the companies’ customers in the individual market, 212,800 claims for medical treatment were denied in the three-year period for reasons relating to pre-existing conditions.

“In the current individual major medical insurance market, applicants undergo an underwriting process to discourage people from purchasing coverage only after they need medical services, which drives up costs for all policyholders,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans. “Health plans recognize that individuals with pre-existing medical conditions have difficulty obtaining coverage and proposed reforms to end pre-existing condition exclusions and discontinue rating based on health status and gender.”

The use of pre-existing condition denials of coverage or claims was banned for children as of Sept. 23, according to the new system set down by the Affordable Care Act (BestWire, Sept. 23, 2010). The practice will be banned for adults by 2014.

This congressional examination was started prior to the passage of health reforms. “All companies voluntarily provided the information requested,” the committee’s report said. “In total, the committee received over 68,000 pages of documents from the companies.”

This latest report emerges as Congress is in recess, having left Capitol Hill to campaign for the Nov. 2 elections. Meanwhile, Democrats have been working to defend the recent health care reforms provided in the Affordable Care Act.

Until 2014, individual and self employed medical insurance is medically underwritten.  That means health insurance companies can decline adults age 19 and older based on their health status.

At healthinsuranceadvisory.org our interactive risk profile tool allows you to obtain immediate feedback regarding your insurability before applying for medical insurance.  It’s fast, free and completely confidential.  No personal information required.  Our online medical insurance quotes make it easy to shop and compare for individual medical insurance plans.  For those individuals or self-employed persons who are unable to qualify for major medical insurance due to pre existing health conditions, we offer health insurance for pre existing conditions.  Let us help you save money on major medical insurance and get covered today!

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