Is hypertension considered a pre-existing condition by insurance?

Hypertension, more commonly known as high blood pressure, affects more than 103 million American adults, according to the American Heart Association.

Hypertension may be considered a pre-existing condition by some insurance companies because it increases the risk of heart attacks and strokes, among other medical events. However, due to current laws, their ability to change or deny your coverage is tightly regulated. Read on for full details of your rights.

A pre-existing condition is a health condition that precedes the application for a health insurance policy. Before 2010, when the Affordable Care Act (ACA) was passed, certain pre-existing conditions were grounds for an insurance provider to refuse to cover you. The ACA already prohibits insurance providers from overcharging people with pre-existing conditions or excluding their conditions from their coverage.

Hypertension itself may be considered a pre-existing condition by insurance companies, according to the Kaiser Family Foundation (KFF). However, it does not necessarily have to be considered a “dismissable” condition that would prohibit insurance companies from providing you with a policy. Before the ACA, hypertension could be a reason for health insurance companies to raise your rates with what was known as a premium surcharge.

Hypertension is tricky because while it can have serious health consequences, it’s also extremely common. Hypertension is related to heart disease, but it is not the same as heart disease.

Preexisting conditions are sometimes determined by what treatment is used, and hypertension can often be treated with lifestyle changes such as diet and exercise. However, some people who have hypertension will need medication throughout their lives.

In short: Yes. Health insurance companies cannot deny you coverage for care because of a pre-existing condition.

Pre-existing conditions are currently covered by health insurance in the United States. It is illegal for insurance companies to deny you or charge you more based on a medical condition you had before your policy started.

If you were enrolled in your current health insurance plan before 2010, you may have been enrolled in a plan that was “embedded” in the old health insurance laws. These types of plans may still deny coverage or exclude coverage for certain health conditions.

There are also products called “short-term” health insurance. These health insurance policies provide a contract of up to 364 days and cannot be renewed for more than 3 consecutive years. Short-term health insurance plans are allowed to make exceptions for pre-existing conditions and are only available in certain states.

Life insurance companies still have the right to charge you extra premiums because of hypertension, and some companies may refuse to offer you a policy based on the condition.

If you need to advocate for yourself to your insurance company, be prepared. The best result will be obtained when you follow these steps:

  • During a doctor’s appointment, ask if treatments and prescriptions are usually covered and if there are alternative treatments in case your claim is denied. You can try to get pre-approved for certain treatments by getting a billing code and calling your insurer directly before starting a new treatment.
  • Gather all necessary documents, including notes from your doctor, other medical professionals, prescriptions and billing documents before making the initial phone call.
  • Set aside an hour where you are not distracted and in a calm, quiet environment to call your insurance company. Make sure this call is made before any deadlines or dates.
  • Write down the questions in advance, including possible follow-up questions. If possible, have someone else listen to the conversation with you to take notes and help you recall information later.
  • Be as pleasant as possible with the insurance agent, note their name and title, and do your best not to raise your voice.
  • Know what you’re entitled to before you contact your insurance company so you don’t compromise or agree to something that shouldn’t be your responsibility.
  • Be prepared to hang up without permission and try again.

Insurance companies can no longer deny your coverage because of hypertension, but there are other financial and mental challenges when living with hypertension long-term.

You may also consider lifestyle changes that can lower your blood pressure if you are able. Managing your blood pressure can reduce your risk of stroke and heart disease and improve your quality of life.

Steps to consider include:

Insurance companies cannot deny you care based on a pre-existing condition, including hypertension. That doesn’t mean working with your insurance company to cover hypertension-related treatment will be easy.

Educate yourself about your condition and the treatment options available to you to get the most out of your insurance provider. You can also treat hypertension at home with a few lifestyle adjustments.

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