What Do You Mean It's Not Covered: A Key Issue: Preexisting Conditions

Preexisting condition: The existence of symptoms which would cause an ordinarily prudent person to seek diagnosis, care or treatment within a two (2) year period preceding the effective date of the coverage of the insured person. A condition for which medical advice or treatment was recommended by a physician or received from a physician within a two (2) year period preceding the effective date of the coverage of the insured person.

This is a huge issue in health insurance issues. Many medical insurance policies limit or exclude coverage for preexisting conditions to keep insurance costs reasonable. Insurance premiums are based on average expectations of loss. If people were permitted to buy insurance coverage after they were injured or developed a serious illness, healthy people would have little incentive to pay insurance premiums. Those who did buy insurance would submit a disproportionate amount of claims. This would cause insurance to be much more expensive. Many disputes over preexisting conditions revolve around charges that an insurance company has gone "fishing" for reasons to deny coverage. If you consider every ache, mishap, oddity you've mentioned casually -- to say nothing of confidentially -- to your doctor, you begin to understand what can happen when an insurer goes fishing. Notice that this term does not only mean a condition for which medical care was actually recommended or received in the past two years -- it also means a condition that would cause a prudent person to seek care or treatment during that time period.