Medical Insurance Confusion

December 16, 2008 5:48 AM

Travel/medical insurance question. In order to qualify for preferred rates I must answer the question "have you in the past 12 months taken medication for cancer?"

I have a chronic leukemia for which there are several treatment protocols, one of which, and the one that I have been on since diagnosis 12 years ago is "watch and wait" which means that I have had no chemotherapy. My IGG is low (probably as a consequence of the leukemia) and I receive monthly IVIG infusions. I'm unsure whether this should be described as "medication for cancer" Would it be deceptive of me to answer "no" to the question?

posted by anonymous to health & fitness (9 comments total)

If there were no financial considerations, how would you answer? I think you'd probably answer "yes." (Though I'm not a doctor and my understanding of leukemia is what I've learned from Gregory House. Therefore, it's not lupus: and that's about all I know.) If you'd say "yes" otherwise, I think the real question here is whether you're willing to comprise your morals for the price of the preferred rate.

If it were me, I'd say "yes," pay the higher rate, and complain to myself about yet another annoying consequence of my own body's shortcomings.
posted by terceiro at 6:43 AM on December 16, 2008

You're better off to call the insurance company and ask, or get your quote over the phone. I know that at my father's insurance brokerage (out-of-country medical insurance) they have binders full of decisions by the underwriters as to what exactly "medication for cancer" includes and does not include.

Insurance is meant to cover unexpected illness and accidents, so if you have a stable condition and there have been no changes recently (any change in medication or treatment in the last few months might exclude any illness related to your condition), it's better to give full disclosure and make sure that you'd be covered just in case something happened related to your chronic leukemia. Otherwise, you risk having a hospitalization claim denied, just to save a nominal percentage on the premium.
posted by kaudio at 6:49 AM on December 16, 2008 [1 favorite has favorites]

You should definitely ask your insurance company. Worst case scenario, you say no, the insurance company finds out and pulls the rug out from under you just as you get sick with something or injured. Who knows, they may even try the insurance fraud angle. Bad, bad, terrible times. Paying more now could save you from financial apocalypse later.
posted by ruwan at 8:57 AM on December 16, 2008

In the best world, you would tell them you get monthly IVIG for treatment of low immunoglobulin G due to chronic leukemia and they would understand what this means and you would be likely eligible for the lower rate. The most honest thing to do is call and see if they consider IVIG to be medication for this purpose.

In the real world, I'm sorry to say that I'm more cynical than that. If it were me, I'd probably take "medication" to mean "drug" and say no. They specify "in the last 12 months," so they're not simply sorting people into have ever had cancer vs not. They didn't ask if you are under a doctor's care for cancer, they asked about medication specifically. Would you consider getting any sort of blood products in response to a non-chronic condition as medication?

Additionally, I may be wrong about this or perhaps it's splitting hairs (get an opinion from your doc!), but the IVIG is treating the low IGG, which is not, in and of itself, treatment for the cancer.

/I guess this is how language-oriented people answer medical-related questions. I admit that you could argue that I'm employing a little bit of "depends on what your definition of is is," but I think that insurance companies play that as well.
posted by desuetude at 8:58 AM on December 16, 2008

It would be considered deceptive, and it would be used as an excuse by the insurance not to pay for the IVIg, which costs thousands of dollars per infusion.
posted by ikkyu2 at 9:26 AM on December 16, 2008

Agree with ikkyu2 here. I don't consider it a "medication for cancer," but if you make any claim on your insurance (cancer related or not) they will use this as a reason to deny payment. You can argue about whether it is legal or fair, but it will most certainly be a big headache for you.
posted by Slarty Bartfast at 10:19 AM on December 16, 2008

Think of it this way: You're worried that if you told the truth it would be a basis for them to deny coverage. If you start from that presumption, things aren't going to be any better when they subsequently find out you didn't disclose a disqualifying treatment. Now, not only are you disqualified, but you've given them a reason to claim fraud and seek reimbursement and possible charges.

Under that scenario, aren't you better off disclosing it, explaining why you don't feel it's "medication for cancer," and seeing what happens?
posted by pardonyou? at 10:51 AM on December 16, 2008

Ask the insurer for its definition of "medication." Some broadly define it as "a substance used in therapy."
posted by terranova at 10:55 AM on December 16, 2008

Please note: I totally defer to those more experienced with administration of insurance or medicine. Feel free to use my thoughts as fodder for righteous indignation, rather than the best course of action for your situation. However, in my defense, I do refer to my first paragraph.
posted by desuetude at 2:15 PM on December 16, 2008