Health or health insurance? That is the question.

May 21, 2010 5:36 PM

I have a medical issue and not so great insurance; should I get treatment for my problem and risk being labeled with a preexisting condition? I know YANAD. But can you give me advice anyway?

I am a student under the age of 26. I've heard that, come September, I can get back on my parents insurance, which will be a great relief as my University insurance plan sucks.

Now for the problem: I have gotten migraines most of my life. I've never sought treatment for them as they've been pretty random (not connected to any stimulus) and (usually) not life-derailing if I take painkillers for them. When I was younger I got them pretty infrequently.

However, in the last year or two I've been getting migraines more frequently and I've had worsening eyesight issues. I go to optometrists and get new prescriptions for my eyes—which aren't that bad by the numbers—but by the end of the day my eyes get really tired and far away things get really blurry. The weirdest thing is that whenever I go to a big store or an airport (any kind of building with big, open indoor spaces) lit by fluorescent lights, something about the wide open space and lighting makes everything seem kind of blurry, and I can't read things 30 feet away. And, I've started to see a connection between my blurry, tired eyes and my migraines.

My significant other has been badgering me about my eyes for a while (like when I should be able to read a sign that's not even that far away and just can't), and I keep telling him it's not a big deal, but now I think he's right and I should probably see an opthamologist.

But my insurance is awful! And I want good insurance someday. I've never gotten treatment for my migraines and they're not on my medical records or anything. I know you are (probably) not a doctor, but should I go to a doctor about this right away, or since there doesn't seem to be anything life-threatening going on, wait until I'm back on a good insurance plan?

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

The answer might depend upon what state you're in. If you're in NY, then you needn't worry: pre-existing conditions can't be used to bar you from getting insured, even for the PE condition.
posted by LOLAttorney2009 at 5:39 PM on May 21, 2010

I was in an analogous situation. I waited three months to get treatment for my condition until I could get insurance.

It didn't matter in the end. The insurance company I ended up with was able to call it a preexisting condition anyway because of something unrelated they dug up from my history. Those three months sucked, and there was no benefit for having waited except the life experience necessary to tell others "Don't wait".

Here's the good news. You're insured! That means that if you are denied coverage by your current insurer, then (depending on your state's laws) you may only have to wait a year from the time your insurers find out about this condition until whatever insurance you have then begins to cover your stuff. Here in Wisconsin, at least, they can't deny coverage for treatments for a preexisting condition if you've been insured continuously for at least a year since the condition was discovered. This means that if you're in Wisconsin or a state with similar laws, I would think it's in your best incentive to just get treated as quickly as possible.
posted by Jpfed at 5:59 PM on May 21, 2010

Please have this looked at. Your eyesight -- or your brain, for that matter -- is not something you want to mess around with. I totally get your logistical/practical concern here, because I have a tendency to make similar rationalizations, but there are some things that you just shouldn't rationalize delaying -- and your eyes are one of those things.

Start by going to an opthamologist; I suspect that the way "preexisting conditions" are considered are very different when it comes to eyesight, so if this is not strictly a neurological issue and more an eyesight issue, your concern may be moot anyway. (As a data point, I've been treated by an opthamologist since I was about 4, and have never had difficulty getting vision insurance because of it. Nor health insurance, for that matter.)
posted by devinemissk at 6:08 PM on May 21, 2010

If the new plan is covered by HIPPA (generally most group plans but not individual health plans) then , you have two protections. One is if you had continuous "creditable" health insurance with a gap of less than x days (60, I think) then the new plan can not exclude pre-existing conditions. Just make sure your current coverage stays in place until you know for sure that you are covered under your parent's policy. So, if you have a reasonable plan now (creditable coverage) and go straight to a HIPPA covered group plan, you won't have to worry at all about pre-existing conditions.

Second, under HIPPA if there was no treatment of the problem in the six months prior to coverage, it does't count as a pre-existing condition even though it existed and was treated before then.

Finally, if neither of the apply, HIPPA says that if you do have a pre-existing condition, they can't deny you coverage overall, just coverage for the condition and that can be for no more than a year.

See the details at the Department of Labor website.
posted by metahawk at 7:13 PM on May 21, 2010

Note: most medical insurance plans will not cover diseases of the eye but not correcting vision with glasses, contact lenses or lasik surgery. You should go to an opthamologist (an MD) and not an optomistrist (may use "Dr." but not a full-trained medical doctor, just an eye person). The opthamologist's office should know how to bill to get the best coverage between your medical and any eye care insurance you might have.
posted by metahawk at 7:17 PM on May 21, 2010

I am not a lawyer.

It's HIPAA. The gap is 63 days. Your current plan being "reasonable" doesn't matter, and possibly conflates issues- if your current plan covers it, and your gap doesn't exceed 63 days, the new plan can't not cover simply because it's a pre-existing condition. That doesn't mean they have to cover it, and if they're are other reasons for them to not to cover it, they may not. But it can't be only because it's a pre-existing condition.
posted by spaltavian at 9:16 PM on May 21, 2010

Ophthalmologist first; ask them for a recommendation for a neurologist who knows migraines while you're there.
posted by fairytale of los angeles at 10:58 PM on May 21, 2010

You should go get treated, and not worry about the pre-existing condition thing. Here's why:

1. You're currently covered by student insurance, and as long as you're a (full-time) student you'll be eligible for this coverage regardless of pre-existing conditions.

2. You're under 26, so even after you leave student insurance (whether it's because it's crap coverage or because you graduate / drop out) you'll have access to your parents' policy, and you'll be eligible for this coverage regardless of pre-existing conditions until you turn 26.

3. Even if #1 and #2 cease to hold (for example, you turn 26 next year and graduate)--AND you don't find a job that offers you health insurance (all job-based health insurance cannot exclude pre-existing conditions or charge you more for having a pre-existing condition)--under the new health reform law you will very likely have access to a state high-risk pool if you're turned down for private insurance because of a pre-existing condition. In this high-risk pool you would have access to health insurance regardless of pre-existing condition, and the premiums cannot be higher than the standard market rate. (See here for more info.)

4. Come 2014, if you still don't have access to health insurance through a job, under the new health reform law no insurance company will be allowed to turn you down if you apply for a policy, and insurance companies will not be allowed to charge you more or exclude any pre-existing conditions.

At this particular point in time, it would be insanity for you to not get this checked out because of worries about how it will affect your future insurability. In less than 4 years the entire concept of "pre-existing condition" will cease to exist in the U.S. insurance market, and between now and then you have access to several layers of insurance safety net (your eligibility for student insurance, your eligibility for your parent's insurance, the fact that as a college graduate you are extremely likely to qualify for job-based insurance after college, and the interim high-risk pools just in case all the rest of it falls through). It would be such a shame for this to snowball into a bigger, more expensive medical problem because of your fears, which might have been reasonable before health reform but shouldn't really be a big issue going forward.
posted by iminurmefi at 7:48 AM on May 24, 2010