Crone’s disease treatment is done — is it a pre-existing condition?

Is Crone’s Disease a pre-existing condition if I have been discharged from further treatment? I’m worried that I won’t be able to get health insurance, even though I’m perfectly fine!

Crone Free

Dear Crone Free,

The pre-existing condition problem only arises when you change health plans.  And it’s only a problem until January 2014, when health reform prohibits insurers from charging more and from denying claims for pre-existing conditions.

Until 2014, a pre-existing condition is any illness that you have received treatment for in the six months before you join a new health plan. The new plan will look back at the six months before you joined to determine whether you had any treatment.  (Whether you expect to have more treatment is not important to the insurer.)

Now, suppose you did have some treatment – an office visit or a test – during those six months.  The insurer still has to pay your claim if you had no gap in your health insurance coverage.  The first time you submit a claim, you will probably get a notice from the insurer — looking for proof of your previous coverage. This is called a “letter of creditable coverage”. It is a form that you would request from your plan; or it may have been sent to you when you ended your coverage.

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.