Can You Be Denied Health Insurance?

Everyone needs health insurance, but acquiring it can be stressful. It can be quite terrifying to live in a world where one small illness or accident can send us into near-crippling debt over medical bills, let alone if we are dealing with a preexisting health condition. Then insurance can literally become a matter of life or death.

According to the United States Census Bureau, in 2017, 28.5 million people didn’t have health insurance for the entire year. Sure, this is only 8.8 percent of the population and it’s statistically improved from the past, but that doesn’t change the fact that literally millions of people are uninsured and therefore, are most likely not getting proper preventative care and are one injury or illness away from severe debt.

The introduction of the Affordable Care Act (ACA) in 2010 gave hope to a lot of us (perhaps, especially those of us already dealing with a medical condition). However, does the ACA protect us from getting denied coverage completely? And, why are so many people left uninsured if insurance is so “affordable?”

So, can we be denied health insurance?

According to HHS, under the Affordable Care Act insurance companies can no longer refuse coverage and/or charge us more for a pre-existing condition. They can also no longer charge women more than men.

However, this new law doesn’t apply to “grandfathered health insurance plans” (plans obtained on our own before 2010). Plus, if an insurance company gives us a reason (outside of a preexisting condition) they still can deny us coverage. Or, they may not deny us an insurance policy outright, but will try to deny claims with other excuses such as “lack of referral or prior authorization,” “procedure not medically necessary,” “not covered by this policy,” “improper coding on paperwork somewhere,” and more

What can we do if we’re denied coverage?

According to, “If [our] health insurer refuses to pay a claim or ends [our] coverage, [we] have the right to appeal the decision and have it reviewed by a third party.” Therefore, if we like our insurance plan and it has been working for us and our needs, then hiring a lawyer who specializes in healthcare and financial malpractice law like Howard Fensterman and appealing the decision with our insurance company may be the best option.

However, considering that, according to a 2018 survey conducted by the American Psychological Association 66 percent of American adults cite health insurance costs as a stressor for them and their loved ones, it may be worth looking into short term health plans. This will allow us to compare prices with our health needs in mind if we haven’t been happy with our health plan, anyway. Hopefully, this way we can eliminate some of the stress from our lives.

But why are so many people still left uninsured?

According to Key Facts About the Uninsured Population, even under the ACA, many uninsured people cite the high cost of insurance as the main reason they don’t have coverage. In fact, they estimated that 45 percent of uninsured adults cite the cost of coverage being too high as the reason they remained uninsured. It seems that the “affordable” part of the ACA may not have applied to everyone and that is why some people remain uninsured.

This tends to mean that low-income families are the most affected by a lack of insurance, leading to even more stress for this demographic. According to the American Psychological Association, more than 63 percent of adults, “cite uncertainty about the future, both with their own health and that of others, as a source of stress.” They address that insurance costs and the “looming uncertainty about the future” as two common stresses surrounding health. Perhaps finding an affordable short term plan is the best option for many. 

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