A preexisting condition is a medical condition that existed before an insurance policy was purchased. Depending on the policy, a preexisting condition may be defined based on when it originated, when symptoms first appeared, or when treatment was first sought. Explain insurance company policies for preexisting conditions
What will be an ideal response?
Answer:
Insurance companies may or may not be able to withhold payment for conditions which existed prior to a patient becoming covered under a contract. This prevents patients from not paying for insurance coverage, then suddenly discovering they have a serious illness and seeking insurance to cover that illness.
According to the Affordable Care Act of 2010, preexisting limitations must be included in the contract (it will depend on legislation whether this law continues to be allowable). The term preexisting is different for each contract. Most often it is defined as a condition for which the patient has sought treatment within a given time period before insurance coverage has begun. If the patient has sought treatment for such a condition within this time period, benefits for treatment may not be covered, or may be limited to a certain dollar amount. Usually, the restraints for benefits will cease once the patient has been covered under a contract for six months or longer. In 2014, preexisting conditions will no longer be allowed in insurance contracts.
Some contracts also have a "treatment-free" period. With this provision, if the patient can go without treatment for a specified period of time (often 90 days), then the insurance carrier will no longer consider the condition to be preexisting and will cover the illness or condition under the normal terms of the contract.
Remember that treatment includes any kind of contact in relationship with the illness, including the office visit or testing which was used to diagnose the illness. It also includes treatment of the condition, tests or office visits to monitor the condition, and filling of prescriptions relating to the condition.
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