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What are pre-existing conditions and are they covered?

| December 22, 2022


     If you were ever diagnosed with any type of health condition or suffered a serious injury, prior to 2013, then you probably understand what preexisting conditions are. But for those who don’t, preexisting conditions are ailments or medical conditions that you had prior to having medical insurance and before 2013, where services received in connection with those ailments and conditions would not be included in your health insurance because they happened before you started the plan. 

     Prior to the Affordable Care Act, an individual could have health insurance and in essence, not be able to use it for what the individual needs care for. I can speak from firsthand experience; I was one of the individuals. In 2007, I was in a horrific car accident. My right hand with all the tendons destroyed was shattered like broken glass, my bladder popped like a balloon, broke my pelvic bone, and broke my pelvic bone. On top of that, my lungs collapsed, and I needed a blood transfusion requiring two pints of blood. Far from just being able to use the bathroom for myself, my bladder caused me some of the most problems.  

     When my bladder “popped” and needed to be reconstructed, it was one of the hardest moments in my life. After they sewed my bladder back together, I was forced to use a suprapubic tube that was installed through my stomach into my bladder, so I could use the bathroom. I couldn’t even use the bathroom for myself.   

     Having a suprapubic tube in your stomach requires a lot of care. A lot of expensive care. You’re constantly needing to have your tube changed, keep the area clean, and constantly be monitored by doctors. If I had had insurance before my accident, the care for my injuries would most likely be affordable, but I didn’t. I had to beg doctors for care. Sometimes they would agree to see me, but it would come at a high price. This may sound far-fetched, but I’ll never forget the shame of having to beg a doctor to see me and then having to sign a paper stating that I will make payments for all the money owed to the doctor for the non-covered services.  

     Prior to 2013, I was unable to get any of the past ailments or injuries I was living with treated with insurance because I had those issues before I had the insurance. When the Affordable Care Act was passed in 2013, it no longer allowed insurance companies to deny claims because of preexisting conditions. This means that the insurance company can not deny a claim, just because you already have an ailment, injury, or current, medical situation.