Will going to the student clinic mess up my insurance in the future?

November 19, 2008 11:11 AM

Will seeking treatment for anxiety and depression make my health insurance less affordable/available in the future?

My student insurance will be ending in the next six months, and after that I will probably purchase an individual policy. I don't anticipate finding a job that would give me access to a group plan.

If i am diagnosed with or treated for depression and/or anxiety, should I be concerned about insurance being less available or more expensive, and, if so, what are reasonable steps to take? I'm more interested in empirical data and information about relevant laws and health insurance company policies than anecdotes, but don't let that stop you.
I'm in the United States.

posted by anonymous to work & money (16 answers total)

I can tell you what I know from personal experience and what I've learned as a mental health professional: yes, it will become very hard for you to get insurance, and the cost will go up exponentially. I am uninsurable, and have been denied by multiple insurance carriers. Several times I've been fortunate to have group coverage through an employer, and that's been great, but no private insurer will insure me.

That said, it's possible to receive medical treatment for a mental illness without going through your insurance. Many psychiatrists, therapists, and psychologists have sliding scale payment plans; in addition, if you are low-income, you might qualify for assistance from a low-income mental health clinic. I see a private practitioner, but I pay $45 per visit because he has a sliding scale.

Medication can also be inexpensive. Many of the most common psychotropic medications are now generic, and covered by the $4 prescription plans that Walmart and Target both have. If you and your doctor feel you need a more expensive, brand name medication, the drug companies will cover you free of charge if you fall within certain income brackets. As a last resort, there are a number of reputable Canadian pharmacies online (this is what I use) that provide the same medications for much lower prices.

Please don't let insurance concerns stop you from receiving treatment if you feel you really need to. Mental illness is serious--think of it this way: if you got cancer, your insurance would also go up--but you wouldn't leave the cancer untreated for that reason, right?
posted by catwoman429 at 11:29 AM on November 19, 2008 [3 favorites]

Unfortunately, it might - depending on the state, it could make it more expensive, or denied completely. If you plan to buy a policy, you may want to consider keeping any treatment off the books (i.e., pay cash).
Not to scare you, but if you get denied, you will have to always report that in any future applications...which can affect those future applications...

After Treatment for Mental Illness, Fight for Insurance Often Follows

The downside of making postpartum depression sexy
posted by susanvance at 11:29 AM on November 19, 2008

Where do you plan to live? Because I think it depends on the pool in your area. Can you call an insurance company in the city where you want to live (anonymously) and ask them?
posted by cda at 11:30 AM on November 19, 2008

Yes. It will, from what I've seen on previous MeFi threads. I gather it will pretty much screw you entirely with regards to private insurance, for life. Sorry. I pay totally out of pocket ($60 on sliding scale) for my shrink so I will not get screwed if I ever don't have insurance from a job.
posted by jenfullmoon at 11:33 AM on November 19, 2008

Yes, this is a bad idea because you'll be judged against it when your premiums are evaluated again. Anywhere else in the world this is a non-concern of course. (God Bless America.)
posted by rokusan at 12:03 PM on November 19, 2008

Anywhere else in the world this is a non-concern of course. (God Bless America.)

Including the couple of states in the US with guaranteed issue individual coverage (God Bless Massachusetts). I would expect that fixing individual insurance access issues will be one of the first health policy things addressed by the new administration. Pre-existing condition exclusions and inaccessibility of individual insurance are not compatible with a long-term goal of getting everyone health coverage.
posted by MarkAnd at 12:20 PM on November 19, 2008

MarkAnd, I really hope so but I'm trying not to set my expectations too high.

A friend was treated for depression and, even though his doc called it "anxiety" to make insurance not so much of a problem, he was still denied when he quit his job and looked for an individual policy. It was so expensive that he ended up changing his career to get insurance. I think everyone should ideally get treated but you have to keep in mind that it will be on your record for a very long time.

Last time I filled out a for for individual insurance they wanted info going back 10 years and had access to pharmacy records so they could tell what drugs you don't put on your application. I've thought about paying cash but at every doctor's that I've been to they demand your ss#, which could link it to you. I'm pretty paranoid about the whole industry so I'm not sure how far it goes in reality.
posted by Bunglegirl at 12:41 PM on November 19, 2008

I does depend on your state, and the insurer. Some private policies will allow coverage if you can show proof of prior coverage for the pre-existing condition, but it's entirely up to the insurer. That said, that doesn't mean they won't jack your rates up through the roof for the privilege of having coverage. Depression is a red flag for insurers. It's not as big a red flag as allergies, though.

I'm pretty paranoid about the whole industry so I'm not sure how far it goes in reality.

The industry maintains a clearinghouse for insurance claims. They have access to pretty much every claim you've ever made...prescriptions, broken bones, suspicious infections. That's how, when you apply for coverage, they will sometimes question you about some exam you had 12 years ago and had completely forgotten.
posted by Thorzdad at 1:11 PM on November 19, 2008 [1 favorite]

Yes. (This is why our system needs reform, now you have to decide which is more important and you shouldn't have to)
posted by caddis at 1:21 PM on November 19, 2008

There is one obvious way around this, though it may not be what you're looking for: there are plenty of policies that exclude psychiatric coverage. Such insurers won't give two bags of rocks whether or not you've received treatment for depression or anxiety, because they wouldn't pay for it either way.

Granted, this doesn't help you if you need further treatment for those issues, but it sure beats not being covered at all. Being insured for everything but mental issues and then paying for those out of pocket may be expensive, but it may well be cheaper than paying exorbitant pre-existing condition premiums, and it will be far cheaper than, say, breaking your arm while uninsured.

As you're young and presumably in good health otherwise, finding insurance shouldn't be too big of a deal, even if you need psych coverage. Health insurance for people under 30 is dramatically cheaper than for those over 40.
posted by valkyryn at 1:36 PM on November 19, 2008 [1 favorite]

Paying cash or otherwise going off the books won't increase your insurability unless you are willing to commit fraud. The disclosures sought are whether you have had a condition and whether you have sought treatment, not how that treatment was paid.

It may be that the Obama reforms will eliminate past mental health treatment as a rating event for individual-issue health insurance (I rather doubt it, at first). In health insurance, this dilemma should be relieved as reforms ultimately eliminate the private issue market more or less completely, leaving everyone in the standard group coverage models which pre-existing conditions and treatments are of less relevance.

However, disclosure will certainly continue to be a factor in life insurance, disability insurance, and some forms of individual liability insurance (malpractice, errors and omissions, bonding for operating dangerous equipment).

However, there's no obvious solution to the disability, life and liability insurance issues. Only a minority of people have such coverage and the adverse selection problems could be intractable if people with serious risk factors don't have to pay premiums aligned with their risks. The best thing the mental health community could do would be to prove that persons with histories of mental health treatment don't have higher disability claims, death rates, liability losses than the general population.
posted by MattD at 1:43 PM on November 19, 2008 [1 favorite]

I have single-payer "coverage." Yes, a diagnosis of depression could doom you for a good chunk of time.

Like the credit agencies, there's a central clearinghouse of medical data (the Medical Information Bureau or some other name that becomes MIB). And like credit agencies, they can screw up. I was diagnosed with major depression in 1991. Seven years later, I applied for health insurance and was denied.

I contacted MIB to find out why. They said I was "psychotic" and unable to hold down a job. When I disputed it, they discovered that someone had "entered the wrong code" for depression, thus turning me into a psychotic person. Apparently I was psychotic for 7 years and never realized it. I guess that's psychosis for you!

I also called two other health insurance companies. All said that a diagnosis of major depression, even one that occurred 7 years ago without any need for further treatment, would make it impossible for me to get their insurance.

Do what you need to do. It has been my experience that patients aren't the only ones working around a broken system. Doctors do it, too.
posted by PatoPata at 3:48 PM on November 19, 2008

I had extensive mental health treatment in middle school and high school and I made some visits to the psychologist at uni. When I had to go on private pay in 2007 (three years after my last mental health treatment) I had no problems whatsoever. My insurer is HealthNet and I actually have a relatively cheap premium for comprehensive coverage.
posted by miss meg at 6:51 PM on November 19, 2008

Just a note, PatoPata: "single-payer" is a term that refers to state sponsored health insurance. In single-payer systems, there is only one payer: the state. All medical bills are paid through the state funded program, rather than by the individual. The terminology that you are probably looking for would probably be "individually-held private health insurance," but is most certainly not "single-payer."
posted by greekphilosophy at 7:35 AM on November 20, 2008

MattD, the problem is that people with mental illness do die earlier, and have greater rates of disability. In fact, mental illness is one of the largest causes of disability in the country. There was also a recent study (within the last year or so) that showed that people with mental illness, particularly severe mental illness, have drastically shorter life expectancies than those who are not mentally ill.

The real need is for greater funding for public and private nonprofit community-based mental health care (I've worked in both types of agencies), so that underserved populations (homeless, low-income, etc) can have easier access to this type of treatement. In addition, there needs to be an overhaul of the entire healthcare/insurance system, so that it becomes illegal to discriminate against those with mental or other illnesses when they apply for insurance. Until we have comprehensive, widely available, and easily accessible mental health treatment in this country, the increased rates of death and disability among the mentally ill will continue.
posted by catwoman429 at 8:10 AM on November 20, 2008

From the experience of a friend: Yes. It can make a future individual health plan completely unaffordable.
posted by metaldark at 10:45 AM on November 20, 2008