Pre-Existing Conditions

By

Submitted to the Division of Graduate Studies in partial fulfillment of the requirements for
MBA 512: Health Policy and Law

Shepherd University

April 13, 2010

Abstract Imagine paying $500, $600, $700, or $1,000 monthly for health care insurance only to realize these payments were for naught. The health care insurance provider that received these monthly installments has decided whatever is ailing you will not be covered due to a pre-existing medical condition. What if you couldn’t have the luxury of health care insurance at all due to the basis the health care insurance provider has concluded you have a pre-existing medical condition? These are the dilemmas facing millions of Americans
Pacificare also included persons needing automatic rejection from coverage as; being pregnant, expectant fathers, people receiving counseling within the past six months, and currently experiencing symptoms within the last 2 months where a physician has not been consulted. Consumer Watchdog (David S, 2009) also uncovered insurance provider Health Net’s and Blue Cross Blue Shield’s guidelines for persons who can be denied coverage or charged higher premiums for taking certain medications. Health Net’s disqualifiers include, Zyrtec, used for allergies, and Lamisil used for Toe Fungus. Blue Cross Blue Shield’s included chronic tonsillitis, and varicose veins.
The U.S. Department of Health and Human Services (HealthCare.gov, 2011) goes further into what health insurance providers deem pre-existing conditions which can make persons ineligible for coverage or charge higher premiums. “Some plans consider acne, asthma or high blood pressure a pre-existing condition. Others narrow the definition of pre-existing conditions to cancer or diabetes. Sometimes you might have totally recovered from a condition – like a past bout with depression – and it will still count against you”.
Currently health insurance providers are allowed to decide what best fits into their definition of what a pre-existing condition is. Since these definitions are so vague consumers may have paid premiums to providers for