Why Health Insurance Companies Deny Coverage

Many Americans do not have insurance. In some cases, the lack of insurance is due to a person’s inability to pay for insurance, and others may personally choose to not carry insurance. However, millions of people are uninsured because insurance companies have denied them coverage.

Considerations

• According to the U.S. Department of Health and Human Services, some insurance companies will do a thorough review of a patient’s insurance application. During this review they search for medical conditions (often minor) that have not been mentioned. They can then revoke coverage because the patient did not report the condition on their application.

Expensive Medical Conditions

• Health insurance companies will also deny coverage to individuals that have expensive medical conditions. For example, an individual with cancer may have a hard time obtaining insurance.

Minor Conditions

• It isn’t just major medical conditions that can cause an insurance company to deny a person coverage. Even minor conditions such as hay fever can trigger a denial. According to ABC News, a 2-year-old girl was denied coverage when the insurance company told her she didn’t weigh enough. Although the child was healthy, her weight was a consideration for the insurance company.

Theories/Speculation

• According to CBS News, many health-care insurance companies are stacked against an individual. Insurance companies may attempt to cherry-pick the healthiest people and exclude those with even minor problems.

High-Risk Pools

• In some states, when a person is denied health insurance there are still alternatives available. Many health insurance companies have what they call a “high-risk pool” for people that are denied regular coverage. Those in the high-risk pool pay significantly more for their health insurance each month.