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Insurers increased denials by 49 percent because of pre-existing conditions

The four largest health insurance companies denied coverage to more than 600,000 individuals because of pre-existing conditions in the three years before passage of health reform and the number of coverage denials increased significantly each year, according to a report by the House Energy and Commerce Committee.

WellPoint (NYSE: WLP), Aetna (NYSE: AET), Humana (NYSE: HUM), and UnitedHealth (NYSE: UNH) denied health coverage to 49 percent more people over the past two years, refusing to pay 212,800 claims for medical treatment due to pre-existing conditions.

One company cited "improved pre-existing exclusion process" as a way to increase business. Another had a list of 425 conditions that could be used to deny people insurance coverage, including pregnancy, diabetes and heart disease, notes Business Insurance. Other documents in the report showed that people who were surgical candidates, pregnant, female and "treated for infertility within the past five years," and "any applicant with a (body mass index) 39.0 or greater" were denied health insurance without any internal review by the company, Bloomberg reports.

In the current market, insurers needed to have the option of factoring in health status, Robert Zirkelbach, a spokesman for AHIP, told the Wall Street Journal. That discourages people from buying a policy only after they get sick, which increases costs for all consumers, he said. Zirkelbach added that insurers proposed eliminating denials based on pre-existing health conditions as part of the health overhaul, as long as everyone was required to have coverage.

To learn more:
- read the Wall Street Journal article
- check out the Business Insurance story
- read the Bloomberg article
- view the Congressional report

Related Articles:
Secretary Sebelius leads efforts to improve access to coverage for pre-existing conditions

AHA: RAC activity, audits up
RAC lessons: Appeals can work; denials and hospital prep are costly
Health reform currently leaves kids' coverage incomplete

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