Pre-Existing Condition and Denial of Health Insurance
The focus of this work in writing is to examine whether the individual with a pre-existing health condition should be denied health insurance coverage. Toward this end, this work will examine the literature in this area of study. A pre-existing condition is "a medical condition that existed before someone applies for or enrolls in a new health insurance policy. It can be something as prevalent as heart disease which affects one in three adults -- or something as life-changing as cancer, which affects 11 million Americans.' (HealthReform.gov, 2011) A large number of the American population has health conditions that can be qualified as pre-existing conditions by insurance companies. It is reported that insurance discrimination
"...based on pre-existing conditions makes adequate health insurance unavailable to millions of Americans. In 45 states across the country, insurance companies can discriminate against people based on their pre-existing conditions when they try to purchase health insurance directly from insurance companies in the individual insurance market. Insurers can deny them coverage, charge higher premiums, and/or refuse to cover that particular medical condition." (HealthReform.gov, 2011)
Reported as well in a national survey conducted recently are estimations stating that approximately 12.6 million "non-elderly adults -- 36% of those who tried to purchase health insurance directly from an insurance company in the individual insurance market -- were in fact discriminated against because of a pre-existing condition in the previous three years. In another survey, one in 10 people with cancer said they could not obtain health coverage, and six percent said they lost their coverage, because of being diagnosed with the disease." (HealthReform.gov, 2011)
It is reported as legal in nine U.S. states for insurers to reject individuals applying who are "survivors of domestic violence, citing the history of domestic violence as a pre-existing condition. Even when offering coverage, insurers can exclude whole categories of illnesses related to a pre-existing condition. For example, someone with a pre-existing condition of hay fever could have any respiratory system disease -- such as bronchitis or pneumonia -- excluded from coverage." (HealthReform.gov, 2011)
It is reported that thousands of individuals lose insurance every year through a practice called rescission. Rescission means
"When a person is diagnosed with an expensive condition such as cancer, some insurance companies review his/her initial health status questionnaire. In most states' individual insurance market, insurance companies can retroactively cancel the entire policy if any condition was missed -- even if the medical condition is unrelated, and even if the person was not aware of the condition at the time. Coverage can also be revoked for all members of a family, even if only one family member failed to disclose a medical condition." (HealthReform.gov, 2011)
In fact, a recent investigation by Congress into the practice of rescission states findings that almost "20,000 rescissions from three large insurers over five years, saving them $300 million in medical claims11 -- $300 million that instead had to come out of the pockets of people who thought they were insured, or became bad debt for health care providers. At least one insurance company has been found to evaluate employee performance based in part on the amount of money an employee saved the company through rescissions. Simply put, these insurance company employees are encouraged to revoke sick people's health coverage." (HealthReform.gov, 2011)
II. Scope of the Problem
Case Study 1
In 2010 a newborn as denied medical insurance coverage because it was born with a heart defect. Surgery would have corrected the baby's condition but within days of the child's birth the parents of the child learned that the application of health insurance to cover their child had been denied due to a pre-existing condition. The couple was required to pay out of pocket for the child's life saving surgery.
Case Study 2
In another case a 2010 report states that a 45-year-old mother and divorcee was denied health insurance coverage due to a pre-existing condition in the form of a rare genetic disease called C4 Complement Deficiency involving the immune system having 'inadequate levels of complement proteins' leaving the body prone to infections. Carlson states that it makes her body "unable to process bacteria...
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