Can Insurance Companies Deny Insurance for Someone?

Applying for individual health insurance can be an exhausting and exhaustive procedure. The applications ask questions extending into many areas of your life and your family and personal health history. Even though the process may seem confusing, you must fill the paperwork out accurately and completely or your request for health coverage may be denied.

Unfortunately, accidental errors or omissions on insurance applications are not the only reasons insurance companies may deny coverage for individuals or families. Some estimate that as many as 36 percent of all those seeking individual health insurance were denied due to pre-existing conditions. (1) A pre-existing condition may be any condition from which you suffered at the time of your application, from allergies or hay fever to heart disease or cancer.

Although you may be denied access to standard insurance policies, you may still be able to take advantage of group health insurance policies through your employer or through high-risk insurance pools. Group policies spread risk over a larger group of people and so are generally less expensive and more accessible for those with pre-existing conditions or who have been previously denied for individual coverage. Once you have maxed out your high-risk coverage, you may qualify for individual coverage that charges you not more than 110 percent of the average cost of insurance in the state.

Other plans may not deny you coverage but instead offer you limited or conditional coverage that excludes your pre-existing condition for a certain specified period of time. Any claims that could be linked to your condition, including prescription medications or doctor’s visits, could be denied. Other conditions or routine care would be covered. After your conditional period has concluded, you would qualify for full coverage. You may not be subject to the pre-existing condition exclusion period if you previously had uninterrupted health care coverage for at least a year.

1 http://www.healthreform.gov/reports/denied_coverage/index.html

Source: Health Insurance Los Angeles