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Denying Insurance Coverage and Discriminating Against Pre-Existing Medical Conditions


  • Published: 2009-08-11 (Revised/Updated 2010-07-11) : Author: HHS Press Office
  • Synopsis: Under health insurance reform insurance companies would be prohibited from refusing coverage based on medical history or health risk.

New Report Examines Insurance Company Practice of Denying Coverage To or Discriminating Against Americans Who Have Pre-Existing Medical Conditions.

In a new report, "Coverage Denied: How the Current Health Insurance System Leaves Millions Behind," the U.S. Department of Health and Human Services examines the insurance company practice of denying coverage to or discriminating against Americans who have pre-existing medical conditions.

A recent national survey found that 12.6 million non-elderly adults - 36 percent of those who tried to buy insurance on the private market - were discriminated against in the past three years because an insurance company deemed them ineligible for coverage because of a pre-existing condition, charged them a higher premium, or refused to cover their condition. Another survey found 1 in 10 people with cancer said they could not get health coverage, and 6 percent said they lost their coverage because of their diagnosis.

The insurance company practice of denying coverage because of pre-existing conditions is not confined to serious diseases. Even minor problems such as hay fever could trigger prohibitive responses. An insurer could charge high premiums, deny coverage, or set a restriction such as denying any respiratory disease coverage to a person with hay fever, according to the report.

What's more, some insurance companies respond to an expensive condition such as cancer by initiating a thorough review of the patient's health insurance application. If the company discovers that any medical condition, regardless of how minor, was not reported on the application, it could revoke coverage retroactively for the patient and possibly all members of the patient's family, the report said. The practice is known as rescission.

Companies can do this even if the condition found is not related to the expensive condition or if the person wasn't aware of the condition at the time.

At least one company encouraged employees to revoke sick people's health coverage through rescissions, the report said.

Under health insurance reform, insurance companies would be prohibited from refusing coverage based on someone's medical history or health risk. Companies also would be barred from watering down coverage or refusing renewal because someone becomes sick. Companies would have to renew any policy as long as the policyholder pays the premium in full.

The new report is available at www.HealthReform.gov

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