I am not a physician. If you are looking for a complete, technical explanation, you probably should keep looking. As I understand it, even without outside contributors, like too many cheeseburgers, our blood vessels tend to harden as we age.
The problem, at least from a health insurance point of view, is that when blood vessels harden or constrict in younger folk, bad things can happen that could cause some potentially high medical bills.
Currently, unless the government requires otherwise, all private health insurance companies will medically evaluate an application for health insurance for people age 19 – 64. They will take one of the following 5 actions.
APPROVE
Applicants with a history of high blood pressure that is controlled with minimal medical help and have no other health risks are often approved as if they had no problems.
RATE
If an applicant’s blood pressure is controlled with a higher dosage of one drug or requires 2 different prescriptions, they may still be approved for health insurance but charged a higher premium than someone who is not taking prescriptions.
WAIVE
In the event everything else is acceptable, insurance companies have the right to offer a health insurance policy that excludes specific conditions associated with high blood pressure. The document that allows insurance companies to modify their policies like this is called a “waiver” or “rider.”
WAIT
Hypertension is often called the “Silent Killer.” It has no symptoms until it attacks a major organ or bodily system. Once it is diagnosed, it is normally fairly easy for your doctor to prescribe a medication that will control it. Unfortunately, every human body is different. All of our bodies respond differently to the medications doctor’s use.
Once you are diagnosed with high blood pressure, your doctor may have to try several different medications and doses before the right combination for your body is found. Until your blood pressure is controlled by the same medication and dosage for a period of time, usually 6 months, many health insurance companies will have to legally decline your application for right now but will reconsider your application in a few months after your blood pressure is brought under control.
DECLINE
If you have allowed your blood pressure to elevate and have not taken steps to bring it back into normal range or you are taking 3 or more prescriptions to control it, it is likely that your application for health insurance will be declined by a private insurance company.
If that happens, don’t give up. Many states have high risk pools specifically to provide health insurance for those who have been declined by private health insurance companies. If you happen to live in one of the states that do not have state run risk pools, the PPACA authorized a federal high risk pool.
CONCLUSION
The horror stories the politicians used during the health care reform debates about declines is greatly exaggerated. It is true that occasionally someone is too sick for the health insurance companies or ignored their health and allowed small things to grow into large problem. It is also true that that phenomenon does not happen that often.
It helps to apply a little logic. If health insurance companies are in business to pay medical bills, it makes sense they would not run off clients on a whim. All of us have a risk of needing medical care in the future. Unless a person has a significantly higher risk of future medical bills than the average person, health insurance companies are going to find a way to secure them as a client. The options above are the most frequently used techniques.
If you have had a hard time securing health insurance or you anticipate having difficulty, tell your insurance agent up front. Each insurance company has different underwriting criteria. Just because one company has elected to waive coverage for a condition does not mean that another company will not merely charge a higher rate and insure it.
If your insurance agent has been around for any length of time, he/she will know the underwriting trends of the various insurance companies. He/she is not legally allowed to guarantee anything. He/she is required to wait until the insurance company’s underwriter has made a final decision.
Still, he/she should be able to help you understand if the plan you were offered by the health insurance company is the best plan for you or if there might still be another option.
