Any true major medical insurance policy, group or individual, should cover treatment for Lupus as it is an autoimmune disease in the same class as arthritis. Perhaps a person who was issued an individual health insurance policy that was grandfathered under the terms of the health care reform law was issued coverage excluding Lupus as a condition of issuing the coverage but that's about the only context I can think of where this question could arise.
Certainly in the era of health care reform, especially after January 1, 2014, coverage for conditions such as Lupus should not be a big point of discussion. No policy issued after that date can have pre-existing condition exclusions or limitations. That being said, how treatment for conditions such as Lupus are handled from a level of coverage perspective can and do vary from one insurance carrier to the next. First of all, your perception of coverage may be affected by the type of policy you have enrolled in. If you enrolled in a policy with a $6000 deductible then your perception might be that your condition isn't being covered when actually it is but you aren't seeing any benefits until you've met your deductible. In other cases your insurance carrier may have treatment protocols in place that guide your physician on the methods of treatment and types of medications that must be adhered to for treatment of such a condition and these may be a departure from your past experience and usage.
If you are covered under a non-compliant health plan, possibly a limited benefit or indemnity type plan, then it is quite likely you would have little or no coverage for Lupus or be subject to pre-existing condition exclusions and/or waiting periods. Short Term Medical policies, which by nature do not cover pre-existing conditions, are also another possible area where a person could find that Lupus would not be covered.
But, in today's environment, a person suffering from Lupus can get major medical coverage that covers their condition.
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Certainly in the era of health care reform, especially after January 1, 2014, coverage for conditions such as Lupus should not be a big point of discussion. No policy issued after that date can have pre-existing condition exclusions or limitations. That being said, how treatment for conditions such as Lupus are handled from a level of coverage perspective can and do vary from one insurance carrier to the next. First of all, your perception of coverage may be affected by the type of policy you have enrolled in. If you enrolled in a policy with a $6000 deductible then your perception might be that your condition isn't being covered when actually it is but you aren't seeing any benefits until you've met your deductible. In other cases your insurance carrier may have treatment protocols in place that guide your physician on the methods of treatment and types of medications that must be adhered to for treatment of such a condition and these may be a departure from your past experience and usage.
If you are covered under a non-compliant health plan, possibly a limited benefit or indemnity type plan, then it is quite likely you would have little or no coverage for Lupus or be subject to pre-existing condition exclusions and/or waiting periods. Short Term Medical policies, which by nature do not cover pre-existing conditions, are also another possible area where a person could find that Lupus would not be covered.
But, in today's environment, a person suffering from Lupus can get major medical coverage that covers their condition.