Can Blue Cross Deny Me Health Insurance?

Americans regard health insurance as a financial safety net that ensures they will have access to affordable health coverage no matter what medical uncertainty comes their way. Unfortunately, coverage is not equal for everyone, and some Americans with existing medical conditions cannot acquire health insurance coverage at all without paying high insurance premiums or enrolling in a policy that has benefit exclusions.

Coverage Denials

• According to HealthReform.gov, private health insurance companies in 45 states reserve the right to deny health insurance coverage to any person who applies for coverage if the applicant has a medical condition that is likely to affect the profit of the insurer in the future. Because insurers are for-profit companies, many applicants receive insurance denials because of medical conditions as minor as asthma and as serious as diabetes. However, as of September 23, 2010, the act of rescission, or revoking insurance coverage after a policy-holder becomes ill or develops a medical condition, is illegal with the exception of insured individuals deemed guilty of insurance fraud.

Children

• September 23, 2010, was also a milestone for children, who have greater protections than adults with regard to insurance coverage denials. No health insurer can deny new insurance coverage to a child under age 19 because of a pre-existing medical condition. Federal law does, however, allow "grandfathered" health plans that existed prior to the passage of The Affordable Care Act on March 23, 2010, to deny coverage to children because of pre-existing conditions until January 1, 2014.

Employer Plans

• The Health Insurance Portability and Accountability Act regulates the group insurance plans that employers offer to employees. According to the law, insurers cannot deny health insurance coverage to any employee that qualifies for coverage in accordance with his employer's insurance eligibility requirements. However, if the employee has a pre-existing health condition that was not covered by another health insurance plan for at least 63 days prior to enrolling in the employer's group plan, the new insurer may exclude benefits for the medical condition for up to 12 months after enrollment unless the employee enrolls late, at which time the insurer can exclude benefits for the condition for up to 18 months.

The Affordable Care Act

• On January 1, 2014, The Affordable Care Act will enact one of its biggest changes to health insurance industry practices, prohibiting insurers from denying health insurance coverage to anyone because of an existing health condition or medical history. Additionally, insurers will have to provide coverage to those with medical conditions at the same price as policy-holders without medical conditions that carry the same insurance coverage. However, insurers will be able to deny coverage to anyone guilty of insurance fraud, such as falsified age or citizenship information used to obtain coverage.