How to Fight Insurance Declination Due to Statement of Health Issue

Over 46 million Americans are uninsured, and many cannot get individual health insurance because of a pre-existing condition. A pre-existing condition is an illness or injury present before obtaining health insurance. Depending on its seriousness, most insurance companies either deny that applicant or exclude coverage for medical treatment related to that pre-existing condition. However, being proactive and staying informed can help you fight the denial of health insurance because of unfavorable health status.

Instructions

• 1

  Apply for COBRA (Consolidated Omnibus Budget Reconciliation Act). If you received health insurance through your job and lose your job for any reason except gross misconduct, you are eligible for COBRA. You must apply for COBRA within two months of losing your job. Unlike individual health insurance, COBRA will not deny you for a pre-existing condition. COBRA coverage lasts for 18 months, after which you can reapply.

• 2

  Never go more than 60 days without health insurance. Most states have laws stating that insurance companies cannot deny you if you had coverage within the past 60 days. Hence, after losing your previous health insurance, immediately apply for another plan.

• 3

  Seek insurance plans with an exclusion period. There are insurance plans that will accept an applicant but impose an exclusion period of 6-12 months. This means that the person must wait 6-12 months before insurance will cover any medical treatment related to that pre-existing condition. Speak with an insurance agent to find out which insurance plans impose waiting periods.

• 4

  Get a group insurance plan. Unlike individual health plans, insurance companies cannot deny a single group member because of a pre-existing condition. The best group plans are through employers, so learn more about you or your spouse's employer-based plan. If you are a member of a professional organization, an alumni group or a community organization, learn more about their insurance plans. Group plans tend to be more affordable and have more stable premiums.

• 5

  Read up on your state's insurance laws. The more you know about insurance laws, the better prepared you are to fight a denial. Medical underwriting is when insurance companies examine your health status and medical records to determine whether to insure you. Some states, such as New York, New Jersey, Maine, Massachusetts and Vermont, forbid medical underwriting. Other states allow a self-employed person to become a "group of one." Speak with someone from your state's Department of Insurance to learn more about your state's insurance laws.