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A pre-existing condition is a medical condition that existed before you obtained health insurance. It is significant because the insurer may not cover the pre-existing condition for the duration of the pre-existing condition period. The policy will provide for a stated time period within which it will not provide benefits for the condition.
The pre-existing condition exclusion period varies by insurance company, and also by the State in which the policy is issued. Currently, State law regulates the terms and conditions of insurance policies. For example, some States have disallowed certain types of provisions, including mcertain medical conditions to which they might otherwise apply.
All of that may change if there occurs greater Federal involvement in the regulation of health insurance, but the odds are that new laws will apply only upon the expiration of existing insurance contracts and for the issuance of new contracts after such laws are implemented.
The rationale for pre-existing condition exclusions is that medical insurance works the same way other insurances do: that insurance covers fortuitous occurrences, nor ones that are planned, intentional, or predictable. Stated otherwise, you need to have coverage in place before something adverse happens. An analogy is that just like you can't buy auto insurance after an accident to cover the cost of the accident, medical insurance only covers issues that arise unexpectedly after coverage has begun.
Pre-existing conditions are usually chronic and often costly conditions such as:
- Diabetes
- heart problems
- mental illness
- asthma
- COPD
- Hemophilia
- Epilepsy
- Chronic Infections
- a pregnancy prior to coverage
- an injury which occurred prior to coverage.
- multiple sclerosis, etc.
- certain Allergies
- certain skin conditions
If you think you may have a condition that might be pre-existing you can ask the insurance company if there are exceptions and if your physician can confirm you have not suffered or been treated for the problem during the time period designated by the insurance company. Some companies may decide they cannot cover you if you are seeking individual coverage (rather than group coverage).
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Does there have to be a diagnosis to be considered a preexisting condition?
According to my insurance company if you have seen a doctor about the condition it is preexisting.
Is prematurity considered a preexisting condition?
yes
Is tonsilitis a preexisting condition?
Yes, tonsillitis can be considered a preexisting condition if a person had the condition before seeking medical insurance or treatment. Insurers may classify it as such when assessing coverage or premiums.
Is prostate cancer considered a preexisting condition?
If you try to get health insurance and you have cancer, it is considered a preexisting condition.
Would a complete knee replacement be preexisting condition?
Yes. In order to have a knee replacement done you must first have a significant amount of damage to the knee joint. That is your preexisting condition. The knee replacement itself was done to replace the damaged joint and may or may not be considered a preexisting condition.
Is a dislocated shoulder a preexisting condition?
If your shoulder commonly comes out of its socket, then it is a preexisting condition. If it is the first time you have dislocated your shoulder or if you have never dislocated your shoulder, then it is not a preexisting condition.
Is pneumonia consided a preexisting condition?
Yes, a pulmonary embolism can be considered a pre-existing condition. This would only be the case if you had been previously diagnosed with the condition.
Is having a heart cathetor test considered pre existing condition?
Tests, of any kind, are not included in the definition of preexisting condition. You have to be given a definitive diagnosis from that testing in order to have a preexisting condition. If by having a heart cath test, it was determined that you did not need to have one placed, then you do not have a preexisting condition. For example, you may have an MRI/CAT Scan and then a PET Scan to determine if you have cancer, but if they find you do not have cancer, then you are not diagnosed with a condition, therefore cannot considered preexisting. I should add that, generally if a Dr. wants to evaluate for a heart cath, then you currently have or have had issues with your heart in the past. This may be something like a high percentage blockage, irregular heart beat, thickening of the lining around your heart, etc. This would be considered a preexisting condition and future insurance companies may determine that any intervention needed on your heart would be preexisting. However, insurance companies usually have a preexisting time frame (generally 12 or 24 months) in which a condition is no longer consider preexisting. For example, if you were diagnosed with a heart condition 13 months ago and the insurance company you are planning on joining policy is a 12-month limit on pre-existing conditions, then you are in the clear and the preexisting condition clause does not apply to you.
Would multiple sclerosis considered a preexisting condition?
Yes. Depending on your prior coverage, it may or may not be excluded... see links.
Coding a condition as primary when the majority of the treatment is for a preexisting condition?
illegal
Is asthma considered a preexisting condition?
It depends on what is causing the sleep apnea. It is preexisting if it is caused by tonsils, adnoids, or an elongated uvula. It is not preexisting if it is caused by being overweight, or possibly by a deviated septum.
Is an ovarian cyst considered a preexisting condition if it has dissolved on its own months prior to being enrolled in an insurance plan?
An ovarian cyst would not be considered a pre existing condition. You should have no problem getting an insurance plan.
