What can my health insurance company do with this information?

August 24, 2009 1:04 PM

I want to consult a doctor about some possible health problems, but I don't want my insurance company to know about it. What do I do?

For the last three months I have been insured through my very small employer's expensive plan with United Healthcare. Before joining my employer's plan I carried about seven months of short-term insurance, and previous to that I was uninsured.

In a few months I will be able to switch my health insurance to Blue Cross Blue Shield under my partner's very large employer's affordable and comprehensive group coverage. Meanwhile, United Healthcare is vigilantly documenting my medical history.

I'm suffering stomach problems, for which I've recently seen a doctor under my current plan. Because I was afraid of alerting United Healthcare to possible pre-existing conditions, I did not tell the doctor that a) I have a family history of kidney disease and b) I was told last year that I might want a screening for pre-diabetes.

It is time for my follow-up appointment, and the treatment my doctor prescribed has not done much good. In the interest of solving my stomach problem, I would like to be honest with her about my possible medical problems, but I don't want United Healthcare to have any reason to deny my claims, and I also don't want to have any problems establishing coverage with Blue Cross Blue Shield in a few months.

Should I be worried about what United Healthcare might do with this information? To clarify: I don't think either kidney disease or diabetes is an imminent health danger. However, they could be relevant to my stomach problem; I can suffer through until it's time to switch insurers, if necessary, but I'd really like to get started solving this.

posted by anonymous to law & government (13 comments total)

It really depends on the terms of the new plan and how long you have been insured all together. A plan can preex you within certain limitations , e.g. based on the amount of time you've been covered without a 63 day break (which can offset a preex exclusion) and how recently you saw a doctor for your condition (anything longer than 6 months before your new plan's start date can't count against you).

Also, be aware that lying about a condition on an insurance application can be grounds for rescission of the coverage, although it doesn't sound like that's exactly what you are considering doing.

That said, some plans don't bother with preex exclusions anymore anyway, especially larger plans.
posted by Pax at 1:13 PM on August 24 [1 favorite]

It doesn't matter if you go in with your health insurance or not, because if you are diagnosed with something while you're there, it will be a pre-existing condition when you switch over to Blue Cross Blue Shield. You cannot wait?
posted by banannafish at 1:20 PM on August 24

Do insurance companies count family history as a pre-existing condition? In my experience, they don't, but nothing insurance companies do really surprises me anymore. As for the diabetes risk, was the recommendation for testing due to an abnormal blood test, or was it also a suggestion based on family history? If the latter, I don't think it would count as a pre-existing condition either. If the former, how long ago was it? As mentioned above, if it was more than 6 months before your current plan's start date, they can't exclude it.

I wouldn't worry so much about getting coverage with BCBS. Their big corporate plans usually don't even bother with pre-existing condition exclusions.
posted by bedhead at 1:22 PM on August 24

Because I was afraid of alerting United Healthcare to possible pre-existing conditions, I did not tell the doctor that a) I have a family history of kidney disease and b) I was told last year that I might want a screening for pre-diabetes.

This is a little bit confusing to me. You have coverage through your employer, yes? That's called group coverage, and in general when you have group coverage you gain a lot of protections that prevent an insurance company from doing things like discriminating against you because of pre-existing conditions (charging you more or refusing to cover treatments related to that condition).

As Pax's link shows above, it is legal for your company to impose a pre-existing condition exclusion for a time after you join the plan (no longer than 12 months) if they chose--and not all, or even most, companies do. In terms of what United would have to cover for you under your current employer plan, as long as you haven't received treatment within 6 months from a physician for kidney disease or diabetes, your claims for those things couldn't be denied. You're paying good money for your insurance and it'd be a shame for a misunderstanding about why pre-existing conditions are a problem to keep you from getting treatment.

The only reason I can see for you to keep this secret from your doctor because of insurance concerns are if:

(1) Your partner's company imposes a pre-existing condition exclusion period, and

(2) You will have been enrolled in your current insurance plan for less time that that exclusions period (e.g., you'll have been enrolled for 6 months by the time you switch, and the exclusion period for your new insurance is 12 months).

Even if both of those things are true, at most you'd have to deal with a few months of not having coverage for a specific condition before that exclusion period would run out and you'd be fully covered for everything. Weighing the risks of putting off medical care for a potentially serious condition vs. the risk of having to pay out-of-pocket for a few months, I think I'd probably come down on the side of coming clean with my doctor. YMMV though.

Of course, if your partner's company is large, then they probably have an HR person who is responsible for answering employee questions about health insurance, and he could find out for you whether you're worrying over nothing. You should have your partner ask whether there is a pre-existing condition exclusion period and if so, how long it is for. Since your time in your employer's plan counts against that clock (which again, can only be 12 months at the most), if they don't have an exclusion period or have one that is less-long than the time you've been insured on your current plan you should be in the clear--no need to worry at all about what United knows about your health.
posted by iminurmefi at 1:39 PM on August 24 [2 favorites]

In my experience, the big plans can certainly exclude based on pre-existing conditions. What matters is what kind of plan you are buying.
-Large group plans usually are usually sold to large groups. The premiums from the healthy people pay for the care for the sick people. They do not factor in pre existing conditions.
-Smaller plans I am not sure about.
-But individual plans may very well exclude people with pre existing conditions, no matter how big the insurance company is

You are talking about your partner's "large group coverage." So that sounds very reassuring

To answer the specific question: If you are paying out of pocket for care, then your current insurance company has no standing to get any information from that visit. It might be difficult for her office staff to segregate specific information thought. And once a diagnosis is in your chart it is there for posterity.
posted by SLC Mom at 1:49 PM on August 24

To clarify, you're intentionally defrauding your current health care provider by withholding pertinent information they need to make a judgment on cost of health premiums determined on expected cost of future care? In your question, you're acknowledging that the symptoms and possible health issues you wish to check into are very possibly related to a history of health problems in your family.

As to your original question, try to find a family doctor or connection from a friend who can treat you confidentially? But regardless, what you're asking is unethical and can harm your ability to retain coverage through job transitions.
posted by cgomez at 2:23 PM on August 24

I'm not sure if this applies to you, but according to this Wikipedia article, the Medical Information Bureau keeps records of the diagnoses received by self-employed people who have individual insurance.

Contrary to what the Wikipedia article states, the MIB had my medical history from way back when I had group insurance through an employer--before I went out on my own. They also had an incorrect diagnosis (they said I was psychotic), which led to me being denied health insurance until I challenged them and got it fixed.
posted by PatoPata at 2:27 PM on August 24

If you are truly worried about denial of coverage which is covered by posters above, pay cash and speak with a doctor. Most likely you will get the treatment and confidence you need.

On a side note, it is quite sad US health is the fodder of AskMe in regards to insurance and IKYANMD questions. Best of luck!
posted by Funmonkey1 at 2:28 PM on August 24

Pay cash, go to a different doctor if necessary. Tell them up front that you are going to pay cash. Use a pseudonym.

Ask how much it's going to be, up front.
posted by kathrineg at 2:33 PM on August 24

How many times did I say "up front" in that post?

It's important that you get all the financial information from them before you get tested or seen--because you are likely to experience sticker shock, and because if they know you are paying cash they might be willing to negotiate with you or help you control costs.

It is in no way unethical to protect your ability to receive future, possibly life-saving health care at the expense of a tiny percentage of United Health Care's billion + dollars of profit.
posted by kathrineg at 2:36 PM on August 24

But, yes, listen to the people who are telling you about pre-existing conditions.
posted by kathrineg at 2:38 PM on August 24

From the original poster:

Thank you for all the replies; you are largely setting my fears to rest.

What I have been most worried about is not a diagnosis, but that talking to my doctor about these problems and getting advice from her would constitute a consultation - and that the conversation could come back to bite me when I switch insurers.

Since my partner's HR department is now assuring her that there will be no pre-existing conditions screening when I enroll, I'll go ahead and bare all for my GP. Thanks for suggesting going directly to the source.

posted by mathowie at 3:06 PM on August 24

I jumped from United HealthCare to Blue Cross Blue Shield (from two perspectives: as an employee, and as a consumer of their respective healthcare insurance plans).

There were no problems with pre-exisiting conditions under either plan. Incidentally, the plan I had at UHC really sucked, where the Blue Cross plan is fantastic.
posted by dwbrant at 11:08 AM on August 26