Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Mar 19, 2020

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Doctor explains preexisting condition to patient concerned about health insurance coverage.

If you had the condition before you applied for the medical insurance, it is a pre-existing condition. However, you must have received a diagnosis or treatment for the condition by a doctor or hospital for it to be determined pre-existing.

The following article will provide additional information on pre-existing conditions.

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Why are insurance companies so concerned about pre-existing conditions?

Insurance companies are so concerned with pre-existing conditions because pre-existing conditions affect the company’s bottom line. If you have a pre-existing condition it is pretty much guaranteed that you will be going to a doctor for that condition, receiving treatment for that condition, or possibly taking prescription medication for that condition.

This means the insurance company will be paying claims. By declaring conditions pre-existing, insurance companies avoid having to pay for these services.

You may wonder how you can find an insurance company if you have a pre-existing condition. Well, there are some encouraging policies that most insurance companies have regarding pre-existing conditions. For many conditions, insurance companies will deny coverage only for a pre-determined amount of time such as a year, six months or two years.

This is typically for more common conditions such as allergies, asthma, or eczema. For more serious conditions such as cancer, coverage may be denied all together.

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What is credible coverage?

Some insurance companies may even reverse the pre-existing condition clause, if you can prove that you had creditable coverage when the condition was diagnosed or treated and kept that coverage until applying with the new health insurance company. This is called the creditable coverage clause. Proving creditable coverage is easy.

When you end coverage with one company and switch to another, the former company sends a letter stating the dates of coverage. You can give this letter to your insurance company as proof of creditable coverage. If your former insurance company does not automatically send a letter, just request one.

If your new insurance company does not have any of these options and refuses to cover a pre-existing condition, you can add a rider to your policy that covers your pre-existing condition. A rider is specialized coverage that is not part of the overall plan. This can be expensive and will increase your premium.

So before making this decision, take into consideration everything involved with the treatment of your pre-existing condition such as medications, check-ups, possibility of hospitalization, and chronic pain. If the out of pocket expense will exceed the cost of the rider, getting the rider is a good option. If not, you may want to consider just budgeting money to pay for anything that arises from your pre-existing condition.

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Will current health reforms remove pre-existing clauses?

Current health reform that is taking place now, is working to make it illegal for insurance companies to deny coverage for pre-existing condition. The Patient Protection and Affordable Care Act, part of President Obama’s healthcare reform, was passed in March of 2010 making it a law. Starting in September of 2010, pre-existing clauses for children under the age of 19 will be non-existent. No longer will insurance companies be able to pick and choose what conditions will be covered for children. For adults, the same changes will happen, but not until the beginning of 2014.

Though this legislation is promising, it will take a while to implement and insurance companies will be able to work around it. Insurance companies will do this by simply denying coverage all together to individuals and families with more serious pre-existing conditions. Pre-existing conditions will still be able to be determined based on the medical questionnaire that is required when applying for insurance. Insurance companies can deny coverage just by stating that the applicant is too much of a risk.

Don’t let a pre-existing condition stop you from applying for health insurance. There is a good chance that your condition may only be denied for a short time or a rider may be able to cover your condition. A good place to start looking for a health insurance company is online through an online comparison tool. An online insurance tool provides information from several companies including rates and quotes, so you can choose the company that is right for you and your medical needs.