Reasons Health Insurance can be Denied

Posted by: MedHealth

In recent years one of the hottest, most controversial political debates in America has been the continued disagreement over health insurance. Democrats and Republicans do not see eye to eye on this issue—which might be putting it mildly—but what you hear the Democratic Party saying over and over is that nobody should be denied healthcare in this, the richest country in the world. Republicans, of course, may disagree with the methods of the Democrats, but surely not with their ultimate ideal of health coverage for all. Regardless, the current reality is that many people—many Americans, even—go through life without access to quality healthcare.

And this is, on a very basic level, a shame, though it is also somewhat understandable. After all, insurance is a gamble, and insurance companies are businesses; like any other business, an insurance company would be unwise to take foolish risks, and thus it is unfortunate but not entirely unreasonable that they might decline coverage to some. There are a few reasons why health insurance might be denied. The biggest, of course, is pre-existing conditions. Again, insurance is always a gamble, but, if you have a long history with a recurring illness, the odds are obviously stacked heavily against the insurance carrier. Folks who have long struggled with cancer, AIDS, or even something like diabetes or depression can sometimes be denied coverage.

Similarly, an insurance company might deny coverage if they think your profession is too risky. Again, their top priority is to protect their own bottom line, not necessarily to provide health coverage to anyone who asks. So if you are in a line of work where injury is likely—a firefighter, perhaps—then you should not be surprised if insurance companies prove reluctant to offer you coverage.

There is one final reason why health insurance can be denied, and it’s one that makes a lot of sense: Refusal to pay your bill. This is another regard in which insurance companies are just businesses like any other. If you don’t pay your bill, they will not continue to offer their services. It’s that simple.

These are all legitimate—legally speaking, anyway—reasons for the denial of coverage, but remember that there are other reasons that are illegal. Discrimination is never okay, and certainly not when it comes to healthcare; no insurance company can ever deny services because of race, ethnicity, gender, or even age. Make sure you know your rights, and are aware of exactly why you can and cannot be denied insurance.