Talk:Pre-existing condition

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Suppose someone is switching jobs and, as a result is also switching insurance providers. Which provider, if any, would be responsible for treating the pre-existing condition? If it's the previous job's provider, does the insured have to keep paying premiums for both providers' insurance? —Preceding unsigned comment added by 69.27.187.184 (talk) 19:01, 22 December 2009 (UTC)[reply]

A website that helps answer that question is: http://health.howstuffworks.com/pre-existing-condition.htm. I'm not sure how accurate it is, but the amount of details suggests it is based on an accurate source. —Preceding unsigned comment added by 69.27.187.184 (talk) 21:08, 22 December 2009 (UTC)[reply]

A big part of that section discusses exclusion period, look-back periods,and elimination riders without ever defining them; they are just introduced out of the blue. Those terms should be defined. — Preceding unsigned comment added by Clay Juicer (talk • contribs) 01:43, 5 September 2018 (UTC)[reply]

This page was vandalized and a lot of anti-insurance company material was added with reference to any source (A link was added, but it had nothing to do with the actual material added). I'm willing to revert again and again forever, but I hope that the vandal just gives up. Mask of Picnic (talk) 03:09, 17 January 2010 (UTC)[reply]

I am not a vandal! Nor am I anti insurance company in principle. Some health insurance companies in some places in the U.S. have been allowed to act in a way that defeats the object of insurance, but the problem has happened because the insurance industry in those places has not been regulated well enough to prevent it. Well, you could go on reverting for ever, but that does not make you a constructive editor. It would be helpful if you would indicate here what it is that you object to. I understand that the text that I added was not referenced, but that is not uncommon in Wikipedia. A helpful response would be if you indicated in the text exactly which statements you think need a reference. I will be happy to go and get references for you. So rather than just saying "I object" and delete, please lets discuss the main edit differences you object to. Choose three to begin with and detail them here. We can find references either side of the argument (assuming that there are two sides), discuss them here, and hopefully reach a conclusion about how to present the issues that have emerged. Then we can make a change to the article text. If you have more than three issues, we can then turn to the next three. In time, hopefully we can reach a compromise that better meets the spirit of Wikipedia and makes this article a little less one sided. --Hauskalainen (talk) 23:42, 17 January 2010 (UTC)[reply]

I object to anything that you add that you add solely because of you having a personal vendetta against insurance companies. I hate former President Bush, but I'm not going to go over to 'George W. Bush' and then post "YOU SUCK" over and over again. That's vandalism, just like how you vandalized this article. I won't waste my time with you, I'll just revert you. Mask of Picnic (talk) 02:12, 18 January 2010 (UTC)[reply]

Hauskalainen I agree with everything in your edits, however you have to realize what happens when people look at health care under a different light. For many conservative/Republicans, far right wingers, etc. They look at health care as purely as: survival of the fittest. And by fittest, I actually mean richest. It's sad and wrong I know. But that's their opinion on what health care should be, we have our opinion on what health care should be. --Dana60Cummins (talk) 06:44, 18 January 2010 (UTC)[reply]

I also hate 'George W. Bush' He was all about milking the special interests groups of the world.--Dana60Cummins (talk) 06:47, 18 January 2010 (UTC)[reply]

Pretty much everything that you've just posted is an explicit lie. Left-wingers such as yourself don't give a damn about actually helping sick people-- all you care about is stealing, stealing wealth from richer people to "spread the wealth" around to people. Thus, you create a dependent class of people who are your vassals, who are dependent on you for patronage and thus can vote you into permanent political power. According to you, it's better for a person to go without health care just because they happen to be rich, since that money needs to be stolen by the government and given to enhance salaries for the girlfriend of a government civil service employee. Mask of Picnic (talk) 18:56, 18 January 2010 (UTC)[reply]

No sorry. I live in a area that is all about Impeaching Obama. Currently the hot bumper sticker right now.  :"One Big Ass Mistake America", etc. I am one of the few people that dislike George W. Bush. It's very slanted to the right everywhere around here. 99 out of 100 people here believe health care is as good as it can be. If that's what you believe, well then, you are entitled to your own opinion, just like me. Denying someone coverage because of a pre-existing condition is a crime in my opinion. But I honestly think it that it needs to be examined under all lights. I would never say even a rich person with enhanced salaries, etc should be denied health care, in this country a multi-millionaire can go broke in a matter of one hour if a serious enough condition occurs. It's how we garnish wages here in America that makes health care so touchy. You can get 50% of your wages garnished in most states, if you got medical bills you can't pay. --Dana60Cummins (talk) 22:52, 18 January 2010 (UTC)[reply]

Now that I got that off my chest. This needs to be looked at under all lights, when is why I mentioned what I mentioned earlier. Pre-existing condition and the health care that backs it up is looked at from many points of fews: Completely Evil, the glue that's holding the USA together, something that needs modified, etc. It doesn't matter what any of us wiki users think, it's a matter of acknowledging this issue from all sides. Not just one or two. --Dana60Cummins (talk) 22:59, 18 January 2010 (UTC)[reply]

As well, I consider it a crime that I- a non-smoker, non-drug abuser, non-crossdresser, non-vain person who rarely drinks and keeps my pants zipped up- should be forced to pay for the health care of smokers, alcoholics, sexual experimentalists, swingers cruising for sex, people who can't accept their baldness, drug addicts, prostitutes, etc. If I'm going to be forced into becoming someone else's parents, then I damn well am going to treat those people I care for like parents as my children. Every last tobacco shop and gay bathhouse in America must be closed if I'm going to be covering the tab for STDs and smoker's lung.

Anyways, I've added a great deal to this article that's very anti-insurance company because they were stated in reliable sources. And I've added some material that take the other side because they were stated in reliable sources. Please can it with the BS about 'balance', because I like big corporations as much as you do. But I, unlike socialists who reserve the right to "lie, cheat, and steal for the greater good", don't like making up things either.

I know that you're a socialist who wants to redistribute wealth, and you view your cause as just, but your personal opinion is not relevant. You are not relevant. Neither am I. The only relevant people are those writing informative publications.

I don't care about your opinion. I just refuse to allow you or anyone else to insert material that you just made up from thin air without reference to real life facts into this or any other article. "Balance" does not countering objective facts with imaginary facts, it means bringing other facts to the table. Mask of Picnic (talk) 01:34, 19 January 2010 (UTC)[reply]

Your sources I never challenge once, neither did I challenge your edits. I defended Hauskalainen beliefs, I never defended his edits. Nothing to get worked up about. Note I didn't even add anything to article. However you did assume a extreme amount about myself. I did give my opinion on here, but never wanted anything be added like wise.--Dana60Cummins (talk) 03:33, 19 January 2010 (UTC)[reply]

Being you are a constructive wiki user. You should continue to add your reliable sources that obviously represent your point of few. Because like I said before, this should be analyzed under various points of few. Not just one.--Dana60Cummins (talk) 03:40, 19 January 2010 (UTC)[reply]

And you are a very destructive user, as is Hauskalainen, since both of you are doggedly insistent on forcing your own personal opinions into an article without sources. Such is the methodology of socialism, it's to be expected. I am at a disadvantage here, since- in contrast to your idiotic lies- since I dislike pre-existing conditions in many cases and I've added a great deal of criticism of the concept into this article. Unlike you or Hauskalainen, I'm not an ideology monger who only cares about making sure one side looks good. That's why you both see me as evil, since I lack your diametric binary conception of life in which everything in black and white (e.g. socialist binary materialism).

But I'm not worried here because I'm doing what editors are supposed to be doing. I'm adding sourced information to articles, represented fairly and neutrally. Since neither of you are willing to do that, there's a problem. Mask of Picnic (talk) 04:48, 19 January 2010 (UTC)[reply]

Like I mentioned before, I'm not sure how I'm forcing my opinion into this article without actually adding any information. Let alone being destructive. --Dana60Cummins (talk) 19:11, 19 January 2010 (UTC)[reply]

@Mask of Picnic. "you having a personal vendetta against insurance companies". Care to justify that? I use insurance every year . . for my car, for my home, for my travel. I am free to buy from hundreds of companies and there is real competition and insurable events are relatively random. I am not refused insurance for making a previous claim. However, in health insurance a different paradigm is present. Past experience is a predictor of future experience which is why medical insurance companies drop people like a stone if the law allows as soon as there is an indication of a forthcoming claim or set of claims. That is very good for the owners of the insurance companies if they are not the same as the insured persons as they can keep premiums coming in and insulate themselves from harm as far as they can. That of course does not help at all the sick person who is in need of insurance coverage. This is why medical insurance that is not regulated and where insurance is not compulsory is harmful to the very people who think they are covered. It is why America is reforming its medical insurance model. Maybe you don't like it but that is the truth.

In motor insurance, for example, it is not unreasonable to charge people who have more accidents more than others more because this gives them an incentive to become a better driver. <Similarly in health insurance it is not unreasonable to charge more to people who lead dangerous lifestyles (engage in dangerous sports, are overweight through bad eating habits or who smoke tobacco or drink too much alcohol). But charging more because of age or because of the presence of a health defect of no fault of the individual is unfair if people have been insured all their life. This is why, in European state health care systems, people are not discriminated against in health on the grounds of age of pre-existing conditions. It's not what the people want.

So clearly you are not going to enter into the proper spirit of saying what you is wrong with my edits. Maybe Daba60Cummins is willing to work with me to bring balance to this article against the forces of someone who says "I don't like it".--Hauskalainen (talk) 12:28, 18 January 2010 (UTC)[reply]

You have no right to make up crap that comes out of thin air and that you refuse to provide references for. There's no debate here. Either put up or shut up. Everything you add to this article, or any article, must be a fair and neutral representation of information mentioned by a reference. I don't give a damn about your British Marxist beliefs. It's not relevant here. Mask of Picnic (talk) 18:53, 18 January 2010 (UTC)[reply]

Mask of Picnic, the edits you cite are problematic, to be sure, but be careful about labeling things as vandalism which are in fact just content disputes. Even blatantly

@Mask of Picnic. If you are against the idea of paying for others health care needs then you really should not be interested in insurance at all. Put your money in a piggybank and hope its enough when you need it. The whole idea of insurance is population solidarity, which is kind of marxist, I agree. But if you want to be involved in an act of solidarity (as people who buy insurance do) its not much help when the very vehicle thru which you do this is not mirroring your desires. Of course, there is a fault line in the very system of having optional insurance as people will tend to choose not to buy insurance until they become ill. This is why most countries make health insurance compulsory and make the insurers utilities under tight regulation. Its why

America's Health Insurance Plans wants health insurance to be compulsory if it is to agree to dropping pre-existing conditions clauses. Perhaps you think AHIP is a Marxist organization too.--Hauskalainen (talk) 20:49, 19 January 2010 (UTC)[reply

]

It would be helpful if you stick to the point and at least be constructive by saying what it is that you object to then we can at least begin to re-balance the article.--Hauskalainen (talk) 20:49, 19 January 2010 (UTC)[reply]

Hausk, when I was in elementary school, I learned a valuable lesson. I learned the difference between opinions and fact.

Here is an example. Look at these two statements=

• "Insurance companies are evil."

• "A representative of the group Consumer Reports has criticized the policy for being unfair."

One of them is acceptable in Wikipedia, because it is a fact. The other is an opinion. Unlike you, I understand the difference between the two concepts. Mask of Picnic (talk) 06:31, 20 January 2010 (UTC)[reply]

The purpose of health insurance is basically to protect people from very high costs of health care. However, the commercial health insurance system does not always play fair. Insurance companies try to avoid risk in order to boost their profts. One way they do this is to to refuse to pay for claims made on pre-existing conditions or set special conditions such as higher premiums or else waiting periods for coverage or exclusions for specific body parts.

This is an opinion. It's a argument based on opinion. Unfortunately, these material also does not even describe who is making the claim in the first place.

InsureMe, an insurance quote provider website, has argued that even though health insurance is basically to protect people from very high costs of health care, the commercial health insurance system is not playing fair and are always trying to avoid risk in order to boost their profits.

This is a fact. It is a fact that this company who is trying to sell people things criticizes their competitors. It is fact that it has said these things. The claim is cited to them.

You can refuse to accept the difference, but they exist. Facts are acceptable in Wikipedia, opinions are not. Mask of Picnic (talk) 06:39, 20 January 2010 (UTC)[reply]

(outdent) You can criticise my editing, of course, but the content of that edit was from an industry related source. I don't intend the following to e a debate with you, merely to point out the weakness of the wider issue regarding health insurance. I did not say insurance companies are evil, just that the interests of insurance companies and those of sick people are not aligned. Insurance companies would prefer to pay funds to their shareholders rather than to sick people seeking access to insurance.

So, if the purpose of health insurance is NOT to protect people from the very high costs of health care, what is it for?

If, as you seem you be arguing, there is no systemic failure in the insurance industry regarding pre-existing conditions, why does America's Health Insurance Plans argue that the reason there are 46 million uninsured americans and that many of them go bankrupt through health problems and that this is due to a system failure which even THEY say needs reform?

The Need for Health Care Reform

By now there is widespread awareness that the U.S. health care system is falling dangerously short on several fronts: more than 46 million Americans are currently uninsured and at risk of being driven into bankruptcy by a serious illness, while quality of care varies widely nationwide, with study after study finding chronic underuse, overuse, and misuse of health care resources. As a result, millions of Americans receive inadequate or inappropriate care, and millions of individuals and families are dropping through the cracks in the system, failing to receive preventive screenings and the ongoing care that chronic conditions require. These systemic failures and shortcomings directly contribute to rising health care costs. http://www.ahip.org/content/default.aspx?bc=31%7C44%7C28841

AHIP ties the removal of pre-existing condition clauses (so called "guaranteed issue") to the personal mandate (which is what the legislation before congress does, and its what European health care systems do). The argument is based on the fact that without a personal mandate healthy young people will not buy insurance and this will shift costs on to the sicker and older population. See http://www.ahip.org/content/pressrelease.aspx?docid=25068

Can you also explain why you removed the full Enzi context. Enzi was justifying his voting against a change in the law to prevent women from being regarded as having a pre-existing condition if they have a husband with a record of violence. His argument was that to do so would raise premiums for others and cut others off through affordability. You kept the argument of affordability in but deleted the context entirely. This seems like biased editing to me.--Hauskalainen (talk) 07:31, 20 January 2010 (UTC)[reply]

I removed the text regarding the justification for pre-existing conditions from the section on practices and effects for two reasons. One is that the reason given was spurious - that it is done to make insurance affordable. The other reason is that the reason has already been given in the lead paragraphs - that is, that it is action taken by the insurers to avoid adverse selection. Everyone knows that there is a trade off between the size of medical losses and an insurance company's profitability. Trying to pretend otherwise is stupid. That an insurance company may decide in the long run to reduce its profits by cutting premiums as a a competitive action is also possible but that is a more long run and less direct consequence. It is spurous because the insurer has a choice to cut premiums or take the profit and neither is guaranteed to happen. Either way it does go against the philosophy of providing the sick with health care and it is antithetical to the concept of an effective insurance regime. This is why other countries make health insurance comppulsory and it is why both AHIP and the Democrats propose making insurance compulsory AND eliminating pre-existing coverage limitations.

One can only hope that, once guaranteed issue without preconditions becomes a reality, those people with high health costs who have cruelly been cut off by their insurer buy their next policy from the compaby that denied them . Doing so will affect the profitability of that insurance company and there will be nothing that the company can do about it.

I also added back the Enzi comments in its proper context. It may be embarassing for Mr Enzi's comments in the Senate to be reported but I assure you it was not "venomously biased and criticial" and it did reflect a "netural point of view and balance" Mr Enzi's opinions deserve to be heard because he is a U.S. Senator and had an effect on the issue in a vote in the Senate. --Hauskalainen (talk) 12:00, 20 January 2010 (UTC)[reply]

You removed the text regarding the justification for pre-existing conditions from the section on practices and effects solely because you didn't like it. "I don't like it" is not a valid excuse for deleting information. It's a spurious argument only in your opinion. Opinion =/= fact.

Including the context is fine, but it must be presented neutrally. Mask of Picnic (talk) 20:43, 20 January 2010 (UTC)[reply]

You shouldn't get into an ideological debate with me because I agree with you to a limited extent, and I support requiring companies to drop certain pre-existing conditions (cancer, etc.) as well as an individual mandate. Of course, since you only view that just and necessarily measure as a

trojan horse

to enacting an American version of the NHS (while, in contrast, I support that reform on its merits alone), there are still many differences between us.

The difference between me and you is that I am humble, evenhanded, open-minded, and fair. I respect other people's right to hold their own opinions. You are pompous, arrogant, closed-minded, and ideologically bent. You oppose other people's right to hold their own opinions. I support including both anti- and pro- conditions material in this article because of Wikipedia policies. You oppose including pro- material and wish to add as much anti-material as possible.

I am a Christian, but I will not go to an article about Christianity and remove material about bad things (the Holocaust, the crusades, persecution of gay people, etc) that Christians have done. Nor will I add my personal opinion about Christ in those articles. I wish that you would open your mind and understand that Wikipedia is not your own personal blog, it is merely a form of a newspaper that reprints factual material that evenhandedly balances both sides. Mask of Picnic (talk) 20:50, 20 January 2010 (UTC)[reply]

Because you have not engaged in constructive dialog here and because you have just reinstated your last edit version before continuing to "own" this article like it was your own personal property I have been given little option but to engage in the same tactic. I have not deleted the text on the grounds of "I don't like it" as you claim. I did do because at worst it is wrong and at best it is being deceptive. The reason insurance companies seek to exclude the sick is primarily to preserve their profitability. Because every claim paid hits the bottom line. This is a well known fact and a logical truism. Assigning a claim that it is being done to make insurance more affordable for the poor is, well, how can I put this charitably, ...... inaccurate at the least and downright laughable at best. Health care insurance is there to benefit people who become sick. Denying people who become sick health care is antithetical to the concept of insurance. Which is no doubt why AHIP has admitted that there is a fault line in the current system .... a systemic failure to use the words of AHIP. If anyone is to justify the reason why there are pre-existing condition clauses in American health insurance it has to be AHIP. And they say that it is due to there being no mandate for everyone to have insurance coverage which therefore forces them to pre-screen candidates. Well, in fact there would still need to be a law preventing pre-screening to get to guaranteed issue because as is well known, setting guaranteed issue causes premiums to rise unless the young and healthy are forced to contribute to the pool. But doing this would enable the insurers to ptovide guaranteed issue and even level premiums for all ages and allcomers regardless of health status. That last bt comes not from me but from documents you can find at the AHIP web site.--Hauskalainen (talk) 02:00, 21 January 2010 (UTC)[reply]

Once again, you keep regurgitating "I don't like it" and you keep attempting to "own" the article. You may consider a position to be "wrong", "deceptive", "laughable", etc... but that's your opinion and your opinion only. The fact that some people agree with your opinion means nothing, since other people disagree with you. I'm getting rather tired of talking to you, because you have the mentality of a pre-schooler.

AHIP is a corporate lobbying group that wants to use the government to both (a)force people against their will to buy their product and (b)have the government steal money from taxpayers and give that money to them in the form of subsides. I find it amazing that you're blindly taking their word for it. In one of your earlier edits, you claimed that insurance companies are controlled by Wall Street and only care about their bottom line. Yet here you've done a complete moral 180 flip and you'll blindly accept what the insurance companies put on their lobbying group's website. How silly, I pity you.

If you make coverage more expensive, than less people will have access to it (assuming nothing else changes). This is an objective fact. If I am no longer free to buy apples individually, and must buy apples as well as oranges, then that means that the access of apples decreases. If am no longer able to buy insurance that covers less things (and is therefore less expensive), then I must pay more. This is an objective fact.

You can claim that the system would be more efficient if everyone had expansive coverage, and that may be right. That may be wrong. The point of Wikipedia is to be like a newspaper journalist. We are objective. We fairly report what both sides think. You are a lawyer for one side. You only care about presenting one sides' positions and you wish to censor the other side. That's not acceptable. Both sides must be represented, and represented fairly. Mask of Picnic (talk) 04:00, 21 January 2010 (UTC)[reply]

But you are not objective. You keep inserting bias into the article. Sure you give sources that meet your bias and arguments (like the one about lower costs) that are not generally accepted and deleting items that you do not like. Such as the reference to Mike Enzi and his logic as to why he voted in favour of allowing insurance companies to regard having a violent husband as a reason for denying his wife health care if he beats her up. Your deletion of that quote is a similar case of I don'e like it.

You keep also making diversions into non-issues. I did not say that it would be more efficient if everyone was covered. And I don't believe that would be the case. It would cover everyone but it probably will not be very efficient. If one measures the efficiency of an insurance system by how well the insurance company directs funds to those who need it (i.e. sick people) as opposed to directing those same funds to company salaries, advertising, and shareholders, the the US system of private insurance has to be the least effective in the world.

Stay focussed on your argument. Bring your argument here. Lets work co-operatively to develop the article. And involve others if we cannot agree. --Hauskalainen (talk) 09:12, 21 January 2010 (UTC)[reply]

What is it about "This is not a forum for general discussion of the article's subject" that you people don't understand? From the talk pages guidelines: "Stay objective: Talk pages are not a forum for editors to argue their personal point of view about a controversial issue." 66.191.43.60 (talk) 18:05, 7 December 2013 (UTC)[reply]

You claim to be “humble, open minded, and fair“. And yet you accused me of being a socialist who wants to redistribute wealth. Because of the material I added. --Dana60Cummins (talk) 18:02, 21 January 2010 (UTC)[reply]

I am yet to even add any material to the article. --Dana60Cummins (talk) 18:09, 21 January 2010 (UTC)[reply]

I hope this message reaches those who can help. The lead paragraph is extremely difficult to understand! It's written as if it is for a scientific or academic journal, not for the general public. I had to go to the dictionary three times just reading the first sentence as it has many words I had never heard of before and a phrasing that is confusing! Can't it be rewritten for clarity and for a general public? 204.167.92.26 (talk) 21:26, 23 March 2010 (UTC)[reply]

I agree! The intro paragraph is super difficult to understand! Can't someone please fix it? 140.247.38.208 (talk) 20:54, 24 March 2010 (UTC)[reply]

I have tagged the article with

{{expert}}, to highlight the issues. In future, you could do that yourself. This will also automatically list the article in categories, category:All Wikipedia articles needing clarification and Category:All articles needing expert attention

.

Of course, there are many such articles that require improvements, so there is no guarantee this one will get the attention it needs soon - but we live in hope. Cheers,  Chzz  ►  21:03, 24 March 2010 (UTC)[reply]

I have absolutely no idea what "risk with extant causes that is not readily compensated by standard, affordable insurance premiums" means. I have never heard of the word extant before! 140.247.38.208 (talk) 22:23, 24 March 2010 (UTC)[reply]

Agreed, and no one has fixed this in four years. Maybe I'll take a stab at it. Kendall-K1 (talk) 16:09, 3 July 2014 (UTC)[reply]

It is not clear to me what "Exclusion period" and "Lookback" mean in this context. Suggest that these be defined, or examples given. For example, I go to a MD on day-1 and am diagnosed with AIDS. I buy a policy day-2. Can I start being reembursed for expenses 9 months later if that is my state's exclusion period. Or, I buy the policy 9 months after diagnosis. Am I reembursed immediately, after another 9 months, or not at all?

Related issues: How do insurance co's know whether an applicant has received medical diagnosis and/or treatment for a condition? Under the "known" vs "should have known" standards, is someone better off buying an insurance policy before getting a checkup than after, or doesn't it matter? —Preceding unsigned comment added by 71.197.218.159 (talk) 20:29, 9 July 2010 (UTC)[reply]

http://www.kff.org/healthreform/sidebyside.cfm (Reference for footnote 11) is a dead link. // Internet Esquire (talk) 17:49, 23 August 2016 (UTC)[reply]

One thing you can do in this case is tag the ref with template:dead link, as I did in this edit: [1]. Better, find a working link and replace the url, as I did in this edit: [2]. This is a somewhat unusual case, as the document is still on the Kaiser Foundation web site here [3] but that's an older copy of the document. The one used as a source for this article is no longer available on the KFF web site. Kendall-K1 (talk) 18:09, 23 August 2016 (UTC)[reply]

In the Definition section, it says that 21 states use one definition of a pre-existing condition, 18 use the other and 10 don't specify. We seem to be missing one. Should DC be included here? Then we're missing two.

I just checked the reference. If I counted right, 23 states use "prudent person", 19 use "objective", and 9 (including DC) don't specify. I'll let someone else check my math and make the edit. 165.225.34.110 (talk) 00:50, 1 April 2017 (UTC)[reply]

@