Ask Jeff

How does an insurance company determine preexisting conditions?

When an insurance company refuses to cover a medical expense and labels the medical problem as a preexisting condition, we often get upset and feel that the insurance company is not dealing fairly with us. We need to know how the insurance company comes up with the preexisting designation on medical conditions.

First of all, they look closely at your application. If you have written anything indicating a preexisting condition, that will be their first reason to label a condition
preexisting. But your doctor’s records are also important. Often we forget what we told a doctor during past office visits. And we don’t know everything the doctor
writes down on his records. If an insurance company is seriously investigating coverage for a preexisting condition, they will ask for your doctor’s records. They may
also contact the doctor personally, especially in big cases.

If you have stated something on your application that indicates a possible preexisting condition, even if the doctor?s records do not mention that medical condition, the insurance companies will exclude coverage based on what you wrote on your application.

If you are concerned that all of your preexisting conditions be covered, make sure that you get an insurance plan that covers them. There are plans that provide limited and also total coverage for preexisting conditions.



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