New insurance and pre-existing conditions?

February 12, 2009 5:40 PM

Pre-existing condition and new health insurance, what do I need to know?

I suffer from depression. I was diagnosed in late 2005 and received treatment through the beginning of 2006, covered by the insurance plan from my full-time employer at the time.

Since leaving that job in early 2007, my coverage has been spotty and sporadic, using short term plans just so I wouldn't be totally bankrupted if I got cancer or something. I haven't been covered for the entirety of that time, however... there were gaps of varying lengths between renewals, the longest was probably two or three months. I don't get coverage through my current employer.

I recently signed up for a full-fledged plan, and it starts soon. I disclosed my original depression diagnosis, but what I didn't disclose is that I've been experiencing a pretty severe relapse on and off in recent months. The application didn't ask for that info in explicit terms, but it did ask how I would categorize my mental state over the last few months, and I responded with something to the effect of "mildly depressed" (it was multiple-choice). Any of these may have been the wrong things to do, but they're done already so that's not my question. In my defense, at the time I filled in the application I was actually doing okayish so "mildly depressed" seemed like a reasonable average.

Now I have a letter from the insurance company reminding me that there's a nine-month waiting period for pre-existing conditions, including conditions for which "a prudent layperson would have sought treatment" within six months before coverage. Obviously my original diagnosis falls outside that limitation... my relapse does not, but there's no documented evidence of it other than possibly the response I gave on the application.

So here's my question. If I want to seek treatment for my depression and get it covered under this plan, what should I know? For example, is it going to throw up red flags if make an appointment with a therapist within the first week of coverage? Does it matter that I had short-term coverage during most of this time, but opted not to use it? Or am I overanalyzing the situation entirely?

Thanks.

posted by anonymous to health & fitness (3 answers total)

your insurance policy will have a section describing pre-existing conditions.

if you can get it as a pdf or scan it in, i'd be happy to look at it for you.

i worked in HR a few years back when we were deciding on a completely new health ins plan and carrier. i know more about health insurance than most normal should :)

you can also just get all the documentation together, make some tea or coffee, and have a detail oriented friend go thru everything with you. two heads are better than one at figuring out all the jargon.

obviously IANYinsurance rep, but i'd be glad to help. i know how confusing this can be!

ps if your insurance is thru an employer and you have an HR dept, they should be able to help you with all of these questions and it is, by nature, confidential.

good luck!
posted by sio42 at 6:49 PM on February 12, 2009

...make that..."most normal PEOPLE" ...
posted by sio42 at 6:50 PM on February 12, 2009

Long-term depressive and habitual job/insurance hopper here. After consulting a new psychiatrist on a new health plan recently, I discovered that you might find a loophole if you can get a different diagnosis. For instance, I was able to skirt the preexisting crap by being diagnosed with GAD instead of major depression. (It didn't affect my treatment or meds.) I don't know if this will help you w/r/t where you are in the process, but if you see a doc maybe you could suggest something like this. I think doctors hate the whole insurance industry as much or more than patients, so they may be willing to help in this way.

(I'm not a doctor, mental health prof'l, or insurance person, so take with grain of salt pls k thx. Maybe your issues are more severe than mine and this is not a good idea for you in the long run.)

Also, perhaps a good psych can deflect the "prudent person" nonsense by pointing out that depression can "immobilize" people, making it difficult to make prudent decisions. You can't run straight to the ER if you have a broken pelvis, right?
posted by scratch at 6:30 AM on February 13, 2009