In a few years, health insurers will not be able to use pre-existing conditions as grounds for denying health coverage to individuals. But until then, many people will continue to be subject to the financial and health-related burdens of coverage-denial based on health status.
Data collected during a congressional investigation recently revealed that one out of every seven applicants who applied for health insurance with one of the four largest for-profit insurance providers in the U.S. was denied coverage due to a pre-existing condition. This means 651,000 people were denied coverage by Humana, Aetna, UnitedHealth Group and WellPoint during a three-year time period from 2007 to 2009.
During the same three-year time period, the companies refused to pay 212,800 claims for medical treatment due to pre-existing conditions. Pregnancy, diabetes, heart disease and high Body Mass Index are among the many reasons for coverage denial.
In an article on WSJ.com, Aetna Spokesman Mohit Ghose said the congressional findings “document what many health insurers, including Aetna, have been saying for years — that the individual market needs to be reformed so we can improve access for all consumers.”
The health reform bill mandates that insurers cannot deny coverage to children based on their medical history, but the rest of the population will have to wait until January 1, 2014, to be included in the rule. Additionally, at that time, insurers will not be allowed to charge higher premiums for covering individuals with pre-existing conditions.
“By 2014, health insurance companies selling coverage in the individual market will be allowed to set their rates based only on geography, whether the plan covers an individual or family, age, and tobacco use,” the congressional memo states. “Insurance companies will no longer use medical histories to calculate premium rates.”
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