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Got a Pre-Existing Condition? Read These Tips Before Getting Insurance

pre-existing-conditionsHealth insurance is a necessity, as it bears the brunt of costs associated with medical treatment. Insurance companies can provide coverage, but obviously they need to avoid risk as much as possible to remain profitable. Individuals with pre-existing conditions or people who are in generally poor health are deemed to be high-risk and getting insurance is tricky. Even if they can get a policy, their premiums are likely to be extremely expensive.

Pre-Existing Conditions

The definition of a pre-existing condition is a medical problem that existed before obtaining health insurance. Yet this definition can vary among insurers and types of health plans. Clearly, people with pre-existing conditions can cost an insurance company a lot of money, so they do what they can to either exclude these individuals or avoid paying out on a claim.

You will usually not be able to submit a claim for treatment of a pre-existing condition, and there is normally a nine- to 12-month waiting period for this kind of coverage when it is applicable. This means that when you are offered a policy, the insurer will not provide coverage on a specified condition for a certain period of time. It is also common for insurers to attach a “rider” to your policy that includes a pre-existing condition waiting period or states exclusions of coverage on particular body parts or medical conditions.

Things to Watch Out For

You may be so relieved to find an insurer that you fail to see problems ahead. For example, your insurer may impose stipulations such as prior authorizations or referrals on providers before they are able to give you a diagnostic test, recommend hospitalization, or prescribe medicine. This could delay the receipt of health care, and this can be very dangerous.

It can be frustrating for providers who are experts on health care and know when a patient is in need of help. Instead of getting to do their job, physicians may have to fill out a lot of paperwork, and this further delays the treatment process. Here are some stipulations to watch out for:

  • Referrals: You must be referred to the professional you need to see. You may need surgery to deal with a hernia, but you won’t be allowed to see a surgeon unless you are referred by a doctor. This means you need to pay to see the doctor, and this costs money in terms of deductibles and co-payments.
  • Prior Authorization: Your claim could be denied if it wasn’t pre-authorized by your insurer. Without it, you will be forced to pay the bill. While this often happens with major surgeries, it is now happening for minor procedures as well.
  • Statute of Limitations: This is when a time limit is placed on your claim. Fail to claim within this timeframe, and it will be rejected. If your doctor’s office doesn’t file the claim or misplaces the paperwork, you are the one who has to pay.

When you have a pre-existing condition, you need to be even more wary than usual when it comes to health insurance. Keep your eyes open and don’t be forced to pay more for your coverage than you should. 

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