Should I get these tests done now, and will insurance cover treatment in the future?

December 2, 2009 11:01 AM

A complicated question about a specific medical condition, insurance, and pre-existing conditions.

Hello,
I'll try to explain this clearly- apologies if it's a bit long, the background is necessary!
I live in New York. Three months ago I switched jobs, and the new job told me I had to wait three months for my insurance to kick in. I did not elect to take COBRA or any interim insurance because I recently had surgery and that knocked my premiums up past what I could afford.

About three weeks after starting the new job I got the results back from a pap smear and they said they'd found HPV of the "dangerous, may possibly cause cancer" variety, and that I had to go in for a colposcopy. I explained that I was waiting for my insurance to kick in and they said it should be ok to wait the two months till this happened.
So last week I got laid off. Now there isn't going to be any insurance till I don't know when.

Planned Parenthood will do the colposcopy on a sliding scale that I can just about afford, but my concern is: if I get this test while I have no insurance, and god forbid it turns out I have cervical cancer or pre-cancer that needs to be treated... when I get a job and get insurance, will this then count as a pre-existing condition and not be covered?

I'm really worried about this. The strange thing is that I already have a condition- ulcerative colitis- but whenever I've started a new job, the employer's insurance has covered it with no problem. So that's a pre-existing condition, right? But everyone is saying that this will be different and that I absolutely should wait to get the colposcopy till I already have insurance.

So, two questions. Is there, for some reason, a difference between things like ulcerative colitis and (knock wood) cervical cancer, that would mean that the former is covered while the latter is not? Is it true that if I test positive my new insurance wouldn't cover treatment?

Second question- I know you are not my doctor, but would it be all right to wait until I do get insurance to get tested? It's already been almost three months now and I'm getting really nervous, thinking that something awful and dangerous might be growing inside me and I just have to wait. I know that the earlier you catch these things, the better, but I also know that if it IS pre-cancer, this kind tends to move slowly- is it all right to wait a bit longer?

Thanks...I'm sorry if this is a bit disjointed but the whole subject makes me incredibly stressed out and nervous and I feel a bit helpless in this situation. I want to do what's best for my health without putting myself into years of debt.

Thanks in advance to all of you....

posted by anonymous to Health & Fitness (10 answers total)

IANAD. But, I do know a little bit about both these issues...

1. The difference was probably that you didn't have a sufficient lapse in coverage for your existing conditions to 'reset' as pre-existing under HIPAA. You don't mention where you live, but you might want to look into whether or not your state has a continuing coverage risk pool so you can get insurance and not lose your continuous coverage status. The clock is ticking!

2. You don't say much about your age, etc., or your specific test result. But in the vast majority of cases, the progression from HPV infection to cervical cancer is a 10+ year process. Of all HPV infections, only a tiny amount are those that can cause cancer. Of those that cause cancer, only a tiny number of cases will get cell abnormalities. Of those who get cell abnormalities, only a small number of cases will develop into cancer.

NONE OF THIS IS TO SAY DON'T TAKE THIS SERIOUSLY. It's just to say that if you've been getting pap smears on a regular basis, and nothing was found on your last one (within the last year or two), and your delay in follow up is measured in months, you probably don't have cause to worry too much.

This is by no means a guarantee, but hopefully it will help you research your choices. Feel free to MeFi mail me if you have questions. (I'm not a doctor or a lawyer, but I know a bit about healthcare and health policy.)
posted by j-dawg at 11:18 AM on December 2, 2009

A couple more details it occurs to me I should add...

* The waiting period in your new job does not count towards what's known as a 'significant break in coverage.' So if you went from one job to the other without a period in-between, you should still have that 63-day clock ticking to secure some kind of coverage.

* I wonder if it's possible that you're eligible for COBRA even at the laid off job. Did you enroll in the plan to start the waiting period? Or do they not allow you to formally enroll until after the waiting period? If it's the former, the law might preserve your right to continue coverage under COBRA after the waiting period ends. Check with your HR person, and if they aren't helpful, call your state insurance commission.

I went through a similar situation (different conditions and circumstances, but similar issues) and I know this gets complicated. Keep at it!
posted by j-dawg at 11:43 AM on December 2, 2009 [1 favorite]

And meanwhile you might want to see if you're eligible for Medicaid, or check out some of the clinics affiliated with medical schools.

Good luck.
posted by mareli at 11:44 AM on December 2, 2009

Do what J-dawg suggests ASAP. A lapse in coverage over 63 days will mean huge problems in the future for getting your preexisting conditions covered, and I'd do whatever it takes to avoid it.

Check out Healthy New York for insurance, the state program open to everyone who meets the income guidelines.
posted by susanvance at 12:22 PM on December 2, 2009

follow-up from the OP

I'm 31 and in New York (thought I'd said).

My newer job, the one that just laid me off, did NOT let me enroll in advance when I first started.
I am eligible for COBRA but can't afford it, or other interim insurance, because of a variety of things that skyrocketed my premiums. Private insurance just isn't an option.

I was tested last year and it was positive, but that colposcopy revealed such low-grade cells that they said they weren't even worried about it and would just test me next year. They said they'd expected I would have kicked the infection by now, but the new smear shows that I didn't- so this isn't brand new, hence my concern. Even though it might still be nothing.

My main question, in addition to whether or not I should wait, was- and this is my fault for not making it clear- is there a way to find out for certain whether this would be counted as a pre-existing condition, if I DO get a test and it turns out I have a problem? The regulations are Byzantine and I don't even know where to go to get a solid answer.

Thanks- and I'm sorry for the icky personal details- should have posted them initially but this whole issue stresses me out and I seem to be all over the place in writing about it.

posted by jessamyn at 12:37 PM on December 2, 2009

Sorry, I missed the NY detail.

The problem is that the pre-existing condition question and the break in coverage are pretty tightly linked. If you can preserve continuous coverage, none of it matters. If you can't, than ALL your pre-existing conditions will reset, including the colitis, whenever you restart coverage.

I can tell you from my own experience that from an insurance perspective, having a test result of concern is just as bad -- maybe worse -- than having a diagnosis. (Think about it from the underwriter's perspective: a diagnosis leads to predictable costs. A test with no followup does not.)

I know this isn't the answer you're looking for, but even if it means going into a bit of debt between jobs, keeping your continuous coverage is the single best thing you can do to protect yourself now, and in the forseeable future. With a little luck, the health reform package wending its way through congress will make this a little better in the years ahead, but for now, this is your best bet.
posted by j-dawg at 12:49 PM on December 2, 2009 [2 favorites]

Definitely look at Healthy New York now. If you can get on that before you've passed 62 days from your last insurance coverage, then you will not have issues with pre-existing conditions clauses. I thank providence everyday that I picked up that coverage during a six month waiting period for a new job. Job disappeared right at the same time I was diagnosed with a chronic disease.
posted by saffry at 2:58 PM on December 2, 2009

Unfortunately, an abnormal pap is enough to disqualify you for private insurance, at least with a couple of the major providers. I know this from the recent experience of a friend and my own issues with being denied by BCBS (I was denied for a supposedly benign heart issue, at least according to my cardiologist). I have found the volunteers/staff at planned parenthood to be some of the most helpful, thoughtful medical proffessionals, so I would recommend asking them for advice. I'm sure they are used to working with uninsured patients in a similar situation.
posted by shrimpsmalls at 3:41 PM on December 2, 2009 [1 favorite]

Healthy New York rates are likely to be much lower than your COBRA amount, according to this page the options go as low as $218/month for New York County.

It's a terrible situation I know, but if it were me (speaking from past experience), I'd find the cash however I could, even if it meant taking on credit card debt or borrowing from relatives. Going without insurance when you have chronic conditions is a real gamble and cost you far more in the long term.
posted by susanvance at 4:01 PM on December 2, 2009

Are you still eligible to get on the COBRA insurance? As part of the stimulus package, the federal government will cover 65% of COBRA costs for nine months after a layoff. Here's the info. I am pretty sure you don't have tho elect coverage immediately. Your job should have given you information about this, but given that you quit job #1 and were uninsured by job #2, you may not have gotten it. I know you said the premiums are high, but maybe this will help? You definitely do not want to go more than the 62 days without coverage if you possibly can.
posted by min at 7:21 PM on December 2, 2009