Aptos, CA psychologist: Pre-existing conditions not covered typically 12 months — not forever.

Curious, I went online to see what I could find. What I learned is that YES there can be an exclusionary period (up to a year typically) wherein you pay premiums and the conditions for which you received care during the six months before joining are excluded. So if you sought treatment for Asperger’s Disorder and received care in the six months before then you could not get costs incurred for that condition for the first 12 months of coverage. So YES you have to pay out of pocket for costs for up to a year. But that is not for ever. It is simply for one, long year. See below info: written by Dr. Cameron Jackson Monterey Bay Forum www.FreedomOK.net

“A pre-existing condition can affect your health insurance coverage. If you are applying for insurance, some health insurance companies may accept you conditionally by providing a pre-existing condition exclusion period.

Although the health plan has accepted you and you are paying your monthly premiums, you may not have coverage for any care or services related to your pre-existing condition. Depending on the policy and your state’s insurance regulations, this exclusion period can range from six to 18 months.

For example: Lori S. is a 48 year old woman who works as a freelance writer. She has high blood pressure that is well controlled on two medications. She recently decided to purchase her own health insurance that included drug coverage. The only affordable health plan she could find had a 12-month exclusion period for her high blood pressure. For the first 12 months of her policy, all of her claims (including doctor visits and medications) related to her high blood pressure were denied. However, within that first year of coverage, she also got the flu and a urinary tract infection – both of which were completely covered because they were not pre-existing conditions.

If you are getting insurance at your job, depending on your employer and the health plans offered, you may have a pre-existing exclusion period. However, the exclusion period is limited to 12 months (18 months if you enrolled late in the health plan) and only applies to health conditions for which you sought treatment in the 6 months before you enrolled in the health plan.