Health Insurance Denial Reasons

The vast majority of Americans get their health insurance through a group plan at work, but if you are self-employed, not yet eligible for coverage, or your employer doesn't offer health insurance, you may need to seek coverage on your own. Getting health insurance independently can be an expensive and difficult proposition. You may be denied insurance coverage if you have a medical condition that is considered a negative risk.

Cancer

• Most people who have been diagnosed and are under treatment for various kinds of cancer will be denied health insurance coverage because of the likelihood of future treatment. Even when the patient is covered, some insurance companies, when faced with cancer treatment payouts, have reviewed the patient’s application to find errors that allow them to stop coverage, according to the HealthReform Web site.

Severe Mental Illness

• People with severe mental illness, such as bipolar disorder, major depression, psychopathic personality or schizophrenia, are often denied coverage because of the long-term treatment costs and the need for hospitalization for these disorders.

AIDS

• Americans with AIDS, or even those in professions that include high-risk populations, can have a difficult time finding health insurance companies that will accept them for coverage. AIDS is a disease that requires ongoing medical monitoring, expensive medications and sometimes multiple hospitalizations, so insurance companies find covering these costs detrimental to the company’s bottom line. Even those covered under insurance can find their coverage for new medications limited, according to the New York Times Web site.

Transplant History

• Those who have had transplants in the past may find it very difficult to get individual coverage because of the increased risk of transplant-related complications that can occur. Even those who have coverage may find that coverage is denied because the procedure is considered “experimental,” and coverage for the expensive immunosuppressant medications can be denied.

Renal Failure or Dialysis

• Patients with renal failure who require dialysis may find it impossible to find private insurance because of the costs of treatment and the likelihood of transplant costs in the future.

Other Reasons for Denial

• Almost any condition that may require ongoing medical care can be a reason to be denied coverage or to be required to pay higher premium rates. Those with insulin-dependent diabetes, cystic fibrosis, multiple sclerosis, heart disease, lupus and sleep apnea can all be denied coverage. Such conditions as hay fever, acid reflux, cesarean section or even being a victim of domestic violence can be a reason to deny coverage, according to the MSNBC Web site.