In the healthcare context, a pre-existing illness, also known as a pre-existing condition, is any illness a person has prior to applying for a health care plan. Pre-existing conditions can include chronic or long-term conditions. In some cases, pregnancy can also be considered a pre-existing condition for health policy purposes.
Health care providers and insurance companies often deny coverage for people who have pre-existing conditions, or charge a higher rate of coverage. The reasoning is that people who have pre-existing illnesses are more costly to insure and require more health benefits. As a result, people who have such conditions are often the people who need the most coverage, but typically have a more difficult time obtaining it. Insurance companies could refuse, cancel, or alter coverage for individuals suffering from pre-existing conditions prior to the Affordable Care Act, also known as “Obamacare.”

As of October 2017, given the current legislation in place to remove Obamacare/ACA, it is possible that the protection of discrimination for pre-existing conditions may be removed. 

What are Common Pre-Existing Medical Conditions?

Many medical conditions are considered pre-existing. The following is an incomplete list of pre-existing conditions that, before Obamacare, once disqualified individuals from health insurance: 

  • Lupus
  • Alcohol/drug abuse that was recently treated
  • Mental illness
  • Alzheimer’s disease
  • Multiple Sclerosis
  • Fibromyalgia
  • Rheumatoid arthritis
  • Muscular dystrophy
  • Cancer that was recently diagnosed
  • Severe Obesity
  • Cerebral palsy
  • Pregnancy
  • Hemophilia
  • Epilepsy
  • Diabetes 

What is Pre-Existing Illness Discrimination?

Pre-existing illness discrimination is when a health insurance company denies a person coverage because of her condition that she had before she applied for health care coverage. Before the implementation of the Affordable Care Act, it was common practice for insurance companies to deny coverage to such individuals. As a result, the person suffers from inferior medical care and is forced to pay additional out-of-pocket expenses.
Pursuant to the Affordable Care Act, pre-existing condition discrimination is illegal. Notwithstanding, the current Trump Administration is focused on repealing Obamacare and dismantling everything it stood for. If the Trump Administration succeeds, discrimination by healthcare providers based on pre-existing conditions may very well occur once again.

Can My Insurance Company Deny Coverage Based on My Pre-Existing Illness?

Unless and until the Affordable Care Act is repealed or reformed, it is illegal for insurance companies to deny you coverage. Therefore, if your insurance company refuses to cover or treat you based on your pre-existing illness, file as many appeals as you can with your insurance company. You want to exhaust your administrative remedies so you can demonstrate that you tried to resolve your issue outside of the legal system.
If your insurance provider still denies you coverage, seek help from a skilled attorney. Now that pre-existing condition discrimination is illegal, many healthcare providers try to avoid the extra costs associated with covering someone with pre-existing conditions. This often leads to discriminatory practices.
For example, rather than discriminating against an applicant by a direct denial, the health care provider may make certain services much more expensive than normal, thus trying to discourage the applicant from seeking care from them. Also, some companies may not cover required medications, making the policyholder pay for such medications out-of-pocket (which can be prohibitively expensive).
These practices are not only unethical, but they may be fraudulent.

What’s Happening with the Affordable Care Act?

Since January 2017, the GOP has tried to repeal Obamacare twice, and failed both times. Trump recently signed an executive order making it easier for small businesses to offer cheaper plans with fewer benefits. He also ended billions of dollars’ worth of federal subsidies that help to cover low-income Americans. Nevertheless, these changes to the Affordable Care Act do not directly impact any person with a pre-existing condition, and it is still illegal to discriminate based on such illnesses.

Should I Seek Help from an Attorney?

An attorney can provide you invaluable assistance if you believe you were wrongly denied health insurance coverage. If you are not adequately covered or have been wrongfully denied coverage, consult a qualified personal injury lawyer.