If you or a loved one has been diagnosed with cancer, the very last thing you want to have to think about is whether your treatments will be covered, or whether your insurer will attempt to call your cancer a pre-existing condition to avoid payment. When you are already facing a difficult, uncertain future, dealing with the financial cost of cancer treatment can seem like an unthinkable affront. The American Cancer Society estimates that cancer patients paid $4 billion in out-of-pocket cancer expenses in 2014, although there is no indication of how many patients this included.
It is extremely traumatic for a cancer patient to have to ask the question, “Is cancer a pre-existing condition for health insurance?” In the end, access to quality health insurance is essential to making cancer care affordable. If your insurer fails to live up to its end of the bargain, calling your cancer a pre-existing condition, you may feel hopeless. Attorney Scott Glovsky and his highly experienced legal team are standing by, ready to help those who are facing such a situation.
Is Cancer a Pre-Existing Condition for Health Insurance?
If you are a cancer survivor or have been previously diagnosed with or treated for cancer, your health insurer might claim your cancer is a pre-existing condition, therefore, any expenses associated with cancer in the future will not be covered. A medical illness or injury that is present before you start a new healthcare plan could be considered a pre-existing condition. Chronic or long-term conditions like diabetes, chronic obstructive pulmonary disease, cancer, kidney disease, and other diseases may be considered pre-existing health conditions.
Can Insurance Deny Cancer Coverage Because It’s a Pre-Existing Condition?
Under the Affordable Care Act, health insurance companies may not refuse coverage or charge more to those with pre-existing conditions. Insurers are not allowed to charge more or refuse to pay for essential health benefits for any condition present before coverage begins. Once enrolled, the insurer may not deny you coverage or raise your rates based on your health. Medicaid and CHIP (Children’s Health Insurance Program) may not refuse coverage or charge more in premiums because of a pre-existing condition.
The only exceptions are those with a “grandfathered” individual health insurance policy purchased before March 23rd, 2010. These include plans that were sold by brokers, agents, or insurance companies, but not those individually sold in the market. A health insurer who makes significant changes that reduce benefits or increase costs to consumers could potentially lose its “grandfathered” status.
That being said, private insurers typically rely on their own clinical guidelines and may have policies that exclude treatments based on those treatments being “not medically necessary,” “experimental,” or “investigational.” This can often allow health insurance companies to avoid paying for necessary cancer treatments for those who do not challenge such a decision.
What Should You Do if You Believe Your Insurance Company is Charging You More by Claiming Your Cancer is a Pre-Existing Condition?
Under the Affordable Care Act, an insurance company may not charge you higher premiums simply because you have a pre-existing condition—including cancer. If you think your insurance company is violating this federal law, talk to attorney Scott Glovsky to determine what steps you can take to make your insurer follow the law. If your insurer was grandfathered in, it still may be violating the laws regarding pre-existing conditions. The Law Offices of Scott Glovsky can find out whether this is the case and will advocate on your behalf if it is.
What Should You Do if Your Insurance Company Denies You Cancer Coverage Because It’s a Pre-Existing Condition?
Unless your health insurance policy specifically states that your cancer treatment will not be covered because it is a pre-existing condition, then any denial for cancer treatment coverage will likely be cloaked under the “not medically necessary” umbrella. If your policy excludes coverage for pre-existing conditions like cancer, an experienced insurance denial attorney like Scott Glovsky may be able to have this policy overturned.
If your cancer treatment claim is denied under the “not medically necessary” terminology, Scott can help you file an internal appeal that asks your insurer to reconsider the treatment or test. If this internal appeal is unsuccessful, Scott will guide you on the optimum next step. This step may be an external appeal, or it may be legal action. In an external appeal, a neutral third party will determine whether your insurance company can legally deny your treatment. You do have options, and Scott Glovsky can help you find the best option for you and your unique situation.
How The Law Offices of Scott Glovsky Can Help
So, is cancer a pre-existing condition for health insurance? As detailed above, the answer to this question depends on many different factors, but in most cases, your insurer may not deny your cancer treatment by calling it a pre-existing condition. You may have been diagnosed with breast cancer, prostate cancer, liver cancer, kidney cancer, skin cancer, lung cancer, or another type of cancer.
The Law Offices of Scott Glovsky can help you with any insurance denial related to your cancer diagnosis. If a specific cancer treatment is being denied by calling it “not medically necessary,” “experimental,” or “investigational,” we can help try to get the treatment costs approved. Attorney Scott Glovsky goes after big insurance companies who place profits over people. Scott will fight for the justice you deserve, stepping in to make a positive difference in your health and your future. Contact The Law Offices of Scott Glovsky today.