Health Insurance Question Regarding "Pre-existing Conditions"

Updated on June 22, 2011
C.B. asks from Oskaloosa, KS
11 answers

hi mamas, just thought i would throw this out there in case anyone has ever dealt with this. i am ready to get health insurance going again for our family (yay!) and am super excited, we have the money, we have our budget under control, things are going great. HOWEVER. lately i have been under HUGE amounts of stress, at work, and at home planning a big vacation without my husband (which we just got back from). i have a couple of health concerns that could be very scary or could be nothing, but of course i need a doctor's visit to figure it out. as soon as i get insurance i will make the appointment (in the next week probably, depending on how long it takes to get the insurance finalized, i'm not sure what all that will include). what i'm concerned about, i know that some things, if it is a pre-existing condition the insurance won't cover it, or will fight covering it, etc. i don't know a lot about it but i have heard stories. so my question is, do i schedule an annual exam and just casually mention these things? i feel like i shouldn't schedule an exam saying exactly what is wrong. or because it was not diagnosed till after, would i be ok? (just being paranoid, assuming there "is" anything to diagnose). anyone have experience with this? i hope i'm not being too vague, i AM going to the dr. and just don't want to hear all the "go to the dr IMMEDIATELY!" comments. i'm doing the best i can.

i guess another point to consider is, if i schedule an annual, it might be a month away. normally the only way to get in quickly is to tell them something is wrong so.... hmm.

ok i guess i will elaborate. here goes. (please no lectures!)

last week when travelling, i was sick by the side of the highway. at the end of vomiting, there was dark red blood. i know this could be something simple like an ulcer, or something much more scary. then a few days ago i found a lump on my inner thigh. it's about the size of a nickel. could be like an ingrown hair, or something much worse. so ok. there it is. as i said i've been under a LOT of stress lately. so it could be anything. so again, to simplify, should i mention these things when i make my appointment, or just schedule an annual and then bring them up during the exam? does it matter?

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T.J.

answers from Seattle on

It's only a preexisting condition if you've seen a doctor for it in the past 9 months. If it was a diagnosed condition! So sounds like you're safe to be seen for it.

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K.C.

answers from Orlando on

You are in a tight spot and I feel for you. I hate insurance, becuase it never seems to be there when I need it, and we spend so much money on things we will never (hopefully) need or use! I'm not to sure about the preexisting conditions. I would think because you haven't been diagnosed with anything you don't have conditions, but just concerns. I wish I could give better advice on that for you.
If you do want to get checked out before getting insurance you can use Ameriplan. It is a medical discount company so it does provide huge discounts for things like dr visits, perscriptions, etc and because it's not insurance there is no waiting period and no disqualification for pre existing conditions. You can check and see if your dr accepts it at www.everyonebenefits.com/C.. You do a provider search and put in your zipcode, so you can see who in your area accepts it. When you sign up it's one price and covers everyone in your entire family. It might be worth the $39 a month just to get checked out, you can cancel it at anytime, or you can keep it along with your insurance to get deeper savings.
I think it could help you at this time. Just something to think about. You can PM me with any other questions.
My husband has had a "lump" on his outer theigh (right around the pocket where he carries his cell phone) for over a year and refuses to get it checked out. I just keep praying it's nothing.

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S.S.

answers from Chicago on

Well I think you already know the answer, but are waiting for our backing. Yes those two things could be silly. However, it sounds unusual. For instance not too many people pull over to the side of the road to throw up (that I know of unless they had too much to drink, are pregnant or sick) and S. you are the only person who knows your body and whether or not the lump is unusual on the side of your inner thigh. These do not fall under pre-exisiting conditions unless you have had diabetes or lupus, cancer, etc. etc. or a condition that has been part of an ongoing medical treatment for a time before. But what concerns me is why were you vomiting? Can you trace it to anything-If it's never happened again or before that then I suppose you can talk yourself out of it and that it was isolated- before you go and convince yourself it was hot peppers and that you had to get all out, however it is scaring me hearing this. Yes, stress can couple with not feeling well, but I'm not going to say why don't you wait it out if you were concerned enough to write this, then I think you better make that appointment.And mention it straight out. And pay attention to anything your body continues to do. And find ways to destress if you think some of this is stress related. Good luck.

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J.G.

answers from St. Louis on

If you have not been diagnosed for anything it is not a preexisting condition. If you are asked is there any concerns on the application and you lie they can drop your coverage for that.

What you may want to consider is going for a well visit and pay it out of pocket. If you keep it under the radar the insurance company doesn't know about it. You would actually be amazed how many people do this because they don't want specific things to become part of their record.

Anyway, then you would know if these things are actual issues so if asked the question you can honestly say no.

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K.P.

answers from New York on

I work for NY State Ed department. When I took this position, my HR coordinator let me know that I could not see a specialist for 6 months unless it was an emergency. If I needed a specialist, I would have to pay out-of-pocket. This included maternity coverage, which is why we are trying to get pregnant now, rather than last summer.

A lot depends on the insurance company and type of insurance you select. Read the policies very carefully and see which one would allow you to see a doctor soon rather than later. Some may allow you "full coverage" immediately, but most won't.

Get the insurance NOW and schedule your doctor's appointment for the week after. I'm not encouraging you to drag this out, but by the time you get an appointment (at least a week), schedule the bloodwork AND get the bloodwork back (another week) AND get an appointment (if needed) with a specialist, it will be at least 3 or 4 weeks. Talk openly with your doctor about your insurance concerns and see what he/she suggests!

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J.L.

answers from Chicago on

Get the insurance first if you can wait that long and then once approved and insurance card in tow mention to your doctor about it and go from there.

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J.R.

answers from Glens Falls on

If your new insurance is group insurance it may or may not have a pre-ex clause. If your new insurance is individual coverage, it will 99.9% have a pre-ex clause. Whether group or individual, If you have had a break in coverage of less than 63 days, the pre-ex waiting period must be credited (or satisfied) with the time under your previous coverage. If your break in coverage is more than 63 days, you will have to satisfy the pre ex waiting period, which is typically 12 months. Time spent serving a new hire waiting period is ignored for purposes of calculating the 63 day lapse. Also, if you are waiting for group coverage to begin that has a waiting period after hire before it becomes effective, the new hire waiting period must run concurrently to the 12 month pre ex waiting period. Normally, pre-ex includes any condition for which you received medical advice, care, diagnosis, or treatment within the 6 months prior to the "enrollment date" (the "look back period"). The "enrollment date" is the first day of the new hire waiting period. So if you are already in a waiting period for group health, you are already past your "look back" period. In case none of that works for you, in the state of Kansas there is a high risk pool that may help provide temporary coverage for pre-existing conditions (during the pre ex waiting period). Good luck

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L.L.

answers from Topeka on

I have not had any insurance with a pre-existing clause.Since i'm under my husbands health care insurance I file all the paper work there hasn't been any questions to having pre-existing conditions however filing for private health care insureance there is a clause there is,it is called a waiting period that is 90 days for pre-existing conditions.Now that you've said what your symptoms were these haven't actually been diagnosed prior to the onset of filing for insurance without the actual diagnoses there isn't a pre-exiitng condition because your not be treating for them by a health care professional aka Dr.Make your annual & let them know what other symptoms your having,monitor them at home i'm sure you know when to go to the ER if needed.They may send you out for other testing they always do so don't be surprised,they may have you come in for a recheck & order blood tests.
Stay away from hot/spicy foods things that are acidic & alcohol drinks if it is an ulcer these items will only aggrevate the symptoms,it could be a hiatal hernia or many other things.Is the lump still there?Does it hurt? Is it hard like your forehead(worry) or soft like the tip of your nose(ok)?I mention this because it has been mentioned (Dr. advice) that you can tell when to worry or not to worry but to seek medical attention anyway for any issue a person has.Try to relax.

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V.B.

answers from Houston on

Are you getting group insurance through a job or private insurance? If it's group insurance, they generally don't have a "pre-existing condition" clause (thankfully, since I have had cancer and my hubby just changed jobs). If you're going with private insurance, then I'm not entirely sure how it works. I think you need to do everything in your power to get the insurance ASAP and schedule the appointment however you have to. Normally, a primary care doctor can do an annual exam (including pap smear) and don't take as long to get into as an OB/GYN would. Most definitely mention these issues when you go. As I mentioned, I have been through cancer and you know as well as I do that these symptoms could (not necessarily are) be serious and the sooner these things are diagnosed, the better the outcome.....believe me on this! Even if you end up paying out of pocket, it may be better than the alternative of waiting too long and it being something serious that was better treated early. I will never wait to have a doctor look at me or my family for something serious again. I know now that there is too much at stake and my cancer came out of the blue with no family history, so I never thought that is what it was, but still got checked out right away to be sure. So glad I did! Best of luck to you. I pray these are stress related issues and I hope that you figure out a way to reduce your stress level to avoid future issues. Truly, it isn't worth it. Blessings!

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S.B.

answers from Chicago on

We were applying for insurance last spring and they specifically had a question on the application that asked if there were any issues we weren't disclosing. If you get the insurance and mention the problems occured before you got insurance, chances are they may not cover it-but you may be able to get care at the negotiated rates. I have a pre-existing condition and the agent said they may offer coverage with an exclusion for that condition, or else just charge me more.

S.M.

answers from Kansas City on

When I sold health insurance (AFLAC), they had a policy of the condition needed to be discovered at least 2 months after the policy was in place and the symptoms themselves could not be such that normal reasonable people would have sought treatment sooner.

I'd just wait and do the annual well after the new policy is in place. No one can really prove symptoms because many people are sick with no symptoms...hence the annual exams.

Speaking of lectures.. I haven't had a 2nd mammogram and I haven't had a pap smear in 6 years. I know...I keep telling myself I'll do it.

OOPs... I didn't read about the lump...that's a hard one. If it were me, I'd pray and wait and keep my mouth tightly shut. BUT, if it is growing quickly you might not be able to wait.

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