With healthcare insurance uncertain, should I get my cholesterol checked?

January 20, 2009 3:31 PM

I just lost my job. My health insurance ends at the end of this month and then I will have the option to go on my spouse's insurance or COBRA. My question is: I have an appointment to get my cholesterol checked. Should I keep the appointment?

My doctor on a recent checkup recommended that I get it checked to establish a baseline as I've never had it checked before. (I'm in my mid-30s if that's relevant.) My fear though is that, even though I am healthy and have no reason to believe that I have high cholesterol that it may affect insurance down the road. If I have high cholesterol perhaps my next insurer will see fit to deny my health needs for a pre-existing condition. Even if it comes up healthy, I can see it as having a negative effect. Just the fact that I got checked may enable a healthcare provider to discriminate. So, I'm tempted to cancel the test just to eliminate the possibility that it'll come back to haunt me. Keeping in mind that I'm a fit, healthy person, what do you think I should do?

posted by anonymous to health & fitness (8 comments total)

You need to find out if your state allows insurers to mark up premiums due to pre-existing conditions. Some states don't. If your state is one that does, you might be better off waiting until you're insured again.

You might also look around for a drug store that has in-house labs and does cholesterol checks. My local pharmacy conducts cholesterol screenings/high blood pressure checks and that kind of routine stuff on a regular basis. You wouldn't need to give them your real info, if you were asked for any at all.
posted by mudpuppie at 3:38 PM on January 20

Regarding COBRA plans, the Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) places limits on what pre-existing conditions can be taken into account. From the US Department of Labor's HIPAA FAQ:

What is the Health Insurance Portability and Accountability Act of 1996 (HIPAA)?

HIPAA's is a federal law that limits the ability of a new employer plan to exclude coverage for preexisting conditions; ...[p]rohibits discrimination against employees and their dependent family members based on any health factors they may have, including prior medical conditions, previous claims experience, and genetic information; ....
posted by zippy at 4:25 PM on January 20

Any private-party health insurance you apply for will require a cholesterol test before issuing you a policy, so no concern there in terms of the test results. Indeed, if you detect high cholesterol now and successfully get it under control with diet and exercise, you'll be better off when you reach the private-party market. (If you get it down by drugs, not so much benefit in terms of insurance rates.)

Whatever damage to your rating aside from the results has already been done: if you're a man, having a check-up at your age in the absence of an acute or chronic illness is a bit unusual. Some insurers might give it some modest score as indicator of general poor health or tendency to overuse coverage. Adding a routine test (regularly given to people without any complaints or indicators) can't really aggravate that. I wouldn't lose too much sleep about it; there are probably some insurers who make it a neutral score item -- particularly if they exclude the expense of routine check-ups from coverage, and think that routine coverage on your dime will reduce the risk of bigger claims on theirs. In any event, a good insurance agent who places private-pay policies can advise you on specifics here.

In terms of new group coverage, they won't even check your prior treatment and will have to cover your pre-existing conditions as long as you keep the HIPAA credible coverage going. This means taking your COBRA! Even if you let your COBRA lapse, a new group carrier won't be able to hit you for past medical history, except to the extent that an illness or injury may have been continuing and requiring paid treatment.
posted by MattD at 4:52 PM on January 20

Even if you let your COBRA lapse, a new group carrier won't be able to hit you for past medical history, except to the extent that an illness or injury may have been continuing and requiring paid treatment.

Just building a little on what MattD said... in case you eventually join another group plan, and do not have the uninterrupted coverage for which HIPAA protection applies. Most plan exclusions for pre-existing conditions I've seen are worded so that coverage is excluded for those conditions for which the insured sought or received medical treatment in the 9 months (or other period) prior to the commencement of the plan's coverage.

So let's take the worst case scenario. You have your cholesterol checked and it's sky-high. Then you don't take COBRA continuation (or let it lapse), and you don't join your wife's plan, resulting in a 63+ day break in coverage. Then you join a new plan in connection with a new job. For some period of time defined by the new plan, you may face a denial of benefits for services related to the high cholesterol. The new plan will probably determine this by sending you a questionnaire asking about prior treatment, and may also question your care providers about prior treatment.

That's the downside of having your cholesterol tested regarding group coverage. Whether or not it may come back to haunt you if you later apply for non-group coverage, I'll leave to others, as that's outside my experience.
posted by Snerd at 6:18 PM on January 20

this is not a life or death test. cancel it and just reschedule for when you're on your spouse's insurance.
posted by misanthropicsarah at 8:40 PM on January 20 [1 favorite has favorites]

follow up from someone who woud prefer to romain anonymous.

If I understand everything correctly and you're in the United States, thanks to the HIPAA law as long as you transition to another group insurance plan within 60 days of the termination of your current group insurance coverage (probably both COBRA and your spouse's insurance are group insurance plans) you cannot be denied coverage or claims for pre-existing conditions.

Important tip - if you get a letter from your employer, from a COBRA plan, or from any other insurer notifying you of your insurance ending, keep that letter and keep it easy to find. It counts as documentation of a "HIPAA qualifying event" your next insurer may need.

So I went through a relatively similar scenario: around four years ago I got laid off. I went onto COBRA and ended up starting my own small business.

COBRA maxes out at 18 months. If you call up an insurance company, they route you to a sales office for individual insurance plans, which basically don't have any protections under HIPAA. So everyone I called refused to offer me insurance immediately, based on my height and weight alone (29, 280 lbs.) without hearing anything about my state of health.

The loophole is getting a "small group insurance plan." You can basically just start your own company, have that company sign up for a group insurance plan, and get group coverage with the HIPAA protections that way.

States regulate small group coverage. Most states require insurance companies to offer group plans for groups as small as two people and some require insurance companies to offer small group plans to single individuals.

Fortunately for me, I live in New Hampshire, the land of milk and honey. In NH starting an LLC (Limited Liability Company) is no more complicated than registering your car. (Though anyone will tell you that you should consult a lawyer, draw up well-designed contracts and charter documents, and in general should be very careful in starting a business, which is true.) Also, NH is one of the states that requires the insurance companies to offer small group plans for one person.

So that's what I did when my COBRA ran out. The small group plan is expensive as insurance goes but you can choose any company you want. (Though note that you're usually committing to an entire year at a time.)

I had several pre-existing conditions requiring regular treatment and many prescriptions but for the last 2½ years I've been on the small group plan without any problems. In my particular case, with my particular insurance company, they didn't even ask for a physical or any health tests. And in fact, six months ago a couple of retired relatives were faced with their own COBRA expiring, with one of them in the hospital - so I made them co-owners with the business and added them to the insurance plan. Keeping my fingers crossed but so far everything has worked out okay, their pre-existing conditions and hospital bills have been covered. (One note - when I added them as co-owners, I stopped doing business as my old LLC and registered a new one to do business under. This arrangement was all so that they wouldn't need to receive salaries and the old LLC would stop accruing revenue to avoid any tax problems.)

To roundaboutedly arrive at an answer to your actual question, yes I think you should keep the doctor's appointment; in my experience HIPAA will obviate any pre-existing condition problems so long as you end up transitioning to a group insurance plan rather than an individual plan.

IANAL, et cetera, et cetera.

posted by jessamyn at 8:55 PM on January 20

Most drugstores sell home kits where you test your own cholesterol by pricking your finger. They're usually just total blood cholesterol, which isn't as useful as getting a full panel, but it's better than nothing. I know some doctors dismiss these kits as inaccurate, but when I did it I got essentially the same result as I did in a doctor's office.
posted by Violet Hour at 10:55 PM on January 20

Any private-party health insurance you apply for will require a cholesterol test before issuing you a policy...

This is not entirely true. Whether or not a private insurer requires any testing is entirely up to that insurer. Even though the law governing the coverage of pre-existing conditions does not apply to people moving from a group plan to a private plan, many private insurers will still waive medical tests if you can show proof of immediate prior coverage.

As for COBRA or your spouse's policy...You don't say what sort of policy your spouse has. Is it a group plan through an employer, or a private policy they bought themselves? In any case, COBRA will eventually end and is usually quite a bit more expensive than even the private plan option. I'd opt for your spouse's policy, if it works-out financially.
posted by Thorzdad at 4:26 AM on January 21