Like so many answers to health insurance questions, the heart of the answer is, "follow the money."
Health insurance companies are businesses. Their goal, of course, is to make money, no matter whether they are considered to be a profit, or a non-profit organization. If you get too sick, or if you cost them more than what you have paid them, then they won't make money. They will lose money.
Insurance is a risk business. When you purchase insurance, you do so to protect yourself from losing all your money to an expensive medical problem. You are choosing to pay money up front to protect yourself from paying a lot more money later if you or someone in your family who is covered under your insurance gets very hurt or sick. Your goal is to spend less money than it requires to stay healthy.
In the insurer-patient relationship, one of you will always lose.
Either you will pay too much and not get enough value for your money, or your insurer will pay too much for your care and will lose money by insuring you. It's a gamble for both.
If you need health insurance, and made an application to acquire that insurance, and you were turned down, you will have been turned down because the insurer thinks you are too big a gamble.
How Did They Decide You Were Too Big a Gamble?
To begin the process, you were asked to fill out an application. In the application, you had to specify certain aspects of your lifestyle that were clues. For example, if you stated you are a smoker, you may have been turned down because the insurer decided that at your age, as a smoker, there was a good chance you would get sick and need expensive care.
You also had to disclose any pre-existing conditions. Perhaps you take a statin drug (indicating a problem with cholesterol levels) or high blood pressure medicine (indicating potential heart attack or stroke problems.) It may be that one person in the family you are trying to insure has a pre-existing condition. The health insurer may have turned you all down, or may have consented to insuring all but that one family member with the pre-existing condition. (Note: beginning in 2014, insurers may no longer refuse patients with pre-existing conditions. Further, there are interim solutions for these patients, as found here.)
It's also possible they think you lied on your application. If they asked you about drugs you take or your weight or smoking, and you make statements that are not true, then they may reject your application.
How did they know you weren't truthful? Insurers below to the Medical Information Bureau. Similar to the credit bureaus, the Medical Information Bureau keeps tabs on anyone who has ever had health-related insurance, including any diagnoses they have had. When you applied for health insurance, the insurer checked in with the MIB to see what it could learn about your health. If you withheld information from your application, it probably turned up with the MIB report anyway. You were turned down based on that information, even if your application did not disclose problems.
If you feel that you have been turned down for insurance because an error was made about your health or your family's health, then go back to the company and show them evidence of how they are wrong. While you are doing that, make sure to correct your MIB records as well.
Learn Why "Follow the Money" Is the Answer to More Health Insurance Questions:
- I'm healthy. So why do my insurance premiums increase each year?
- Why does my health insurer deny my care?
- Why won't my insurance cover the doctors I want to see?
- Why doesn't my insurance cover some of the complementary or alternative treatments I would like?
- Why did the health insurance company turn me down for coverage?