Is a Hernia a Pre-Existing Condition?

Hernia is a muscular structure weakness which causes bulging of the abdominal wall. Hernia is caused by heavy weight lifting, incorrect posture, coughing and intense pressure from bowel movement. Examples of certain conditions which can worsen the state of health of the person diagnosed as having hernia are chronic lung disease and obesity. Hernia is more likely to occur if a person smokes, engages in any overexertion activities or has poor nutrition. Hernia is an illness which needs immediate surgical repair so that complications like organ dysfunction can be prevented.

A pre-existing condition is any health problem which a person has been diagnosed in having prior to his or her application in a health plan Pre-existing conditions such as type 2 diabetes , heart disease and hi blood pressure are examples of health problems which health insurance covers and which affect a huge number of the population. Health insurance policies normally deal with pre-existing conditions by offering other benefits but excluding the pre-existing condition from coverage, by including the pre-existing condition but increasing the health insurance policy premiums, place the condition under group coverage named Medical History Disregarded benefit (MHD) and place a waiting period on the coverage of the pre-existing condition. If the person insured in the health insurance is not given medical treatment during the waiting period, the insurance company may probably reconsider covering the pre-existing condition.

It is a well-known fact that a person can’t be denied of health coverage based on of his or her previous medical conditions. However each insurance company has different categories in identifying which medical condition is considered pre-existing. But is hernia a pre-existing condition?

Hernia can be congenital or acquired. If a person is officially diagnosed as having hernia before his or her application to any health insurance policy then there is no doubt that it will be deemed a pre-existing condition. There are medical standards of treatments which insurance companies are expected to follow to determine whether a surgery for a specific illness is medically necessary. In hernia cases, a surgical repair is strongly recommended because if lack proper medical treatment would result to impairment or organ dysfunction.

In a case where a person is diagnosed to having hernia and is given recommendation by his or her doctor to have a hernia surgery, we can assume that this will be considered a pre-existing condition provided that the diagnosis occur prior to the person’s application to a health insurance policy. But does it necessarily follow that if a person has a pre-existing medical condition, the insurance company following the diagnoses would automatically cover the cost hernia repair?

Insurance companies have investigative ways in finding out whether the health problem is technically pre-existing. There should be a proof that the person is officially diagnosed and that the surgical need is made known to the person. Insurance companies will naturally check the person’s medical records to verify if there was an official diagnosis of the hernia prior to the application of health plan. Some insurance companies however provide coverage, like supplemental insurance, even if surgery is not medically necessary.