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Lipoma removal before or after purchasing private health care?
July 29, 2011 5:04 AM   Subscribe

Uninsured American Health Care Problem: Should I have a somewhat large lipoma (benign fatty tumor) surgically removed before applying for private medical insurance, or would it provide the basis for application denial or drastically raised rates?

I haven't had health insurance for years; I'll be in a position to purchase private insurance in a year or two. For several years I've had what I have self-diagnosed as a large benign lipoma (a non cancerous benign fatty tumor) near my shoulder, something that research has indicated would require surgery costing anywhere between 1500-4000 dollars. An unexpected source of income has made it possible to have the surgery done this year, if I'd like. I'd like to talk to a local dermatologist about it soon, get a firm diagnosis, biopsy, surgery options and so on.

Would this likely cause my future private health insurance application to either be denied or to cause an enormous uptick in my premiums? Could I consult this dermatologist in such a way that a future insurance company wouldn't find out (just the assessment without the surgery), ie, "off the record?" Should I wait another year or two until I'm covered privately and then have it done? (I would prefer it out now, its an embarrassing lump). Are there other things about this to consider? (if it's at all relevant, I'm a male in his early 40s)
posted by Auden to Health & Fitness (10 answers total)
 
I think what stands out in this question is the phrase "self-diagnosed."

Are you qualified to be doing this? Isn't this just a little...uh...crazy? Perhaps you should get a proper doctor to check this out, and proceed from there.

IANAD but neither are you.
posted by jpburns at 5:15 AM on July 29, 2011


You are in no position to diagnose a tumor as benign or as fatty. That requires labs. Even if you're right, your "diagnosis" is not supported by actual evidence.

This is a classic example of a "pre-existing condition" which can make it hard to get coverage. Getting it taken care of now and then not telling your health insurance company about it when you apply would constitute material fraud which could wind up getting your coverage denied entirely. There is no such thing as "off the record."
posted by valkyryn at 5:26 AM on July 29, 2011


If your diagnosis is correct - Ins companies can zing you either way.

If you get the surgery, you will get higher rates for having a surgical history.
If you do not get the surgery, you will get higher rates for having a pre-existing condition.
posted by Flood at 5:30 AM on July 29, 2011 [1 favorite]


The rules about PEC are complicated. Depending on what contact you've had with a physican, it may not "exist". Some insurers count things for which you have symptoms and no MD care, but some dont.
posted by a robot made out of meat at 5:41 AM on July 29, 2011


Could I consult this dermatologist in such a way that a future insurance company wouldn't find out (just the assessment without the surgery), ie, "off the record?"

For what it's worth, it's seemed to me that when it comes to personal history, anything that happened outside of America happened somewhere outside space and time and doesn't exist as far as American systems are concerned.

If you get it taken care of in another country with a better heathcare system, you'll be paying full price - an unholy sum compared to what the locals are used to, because you will not enjoy their citizen's health subsidy - but even so it should still be comparable or cheaper than getting it taken care of here - and quite possibly still slightly cheaper even when including the cost of flights, hotel, etc.
I would also think that if done correctly, this would not be on any record that insurance companies have access too, unless they actively sicked one of their investigators onto you.

I am not an expert, but if you haven't looked into medical tourism, perhaps you should?
posted by anonymisc at 6:27 AM on July 29, 2011


Since this condition is self-diagnosed and, thus, does not technically qualify as a "pre-existing condition" since no doctor has made a determination...

1. Get insurance.
2. Wait a few months.
3. Get lump properly diagnosed.
4. Treatment, if necessary.

FWIW, if, in fact, this is a benign fatty cyst, most doctors will not advise surgery unless it is impairing movement, causing pain or poses some sort of health risk. Because of this, even if you have insurance, removal may be considered cosmetic and, depending on your policy, may not be covered.
posted by Thorzdad at 6:41 AM on July 29, 2011 [2 favorites]


Since this condition is self-diagnosed and, thus, does not technically qualify as a "pre-existing condition" since no doctor has made a determination...

I just want to stress that this is not a universal rule. Some insurers have a clause about conditions for which a reasonable person would have sought treatment for just this purpose. Eg, I can't sign up for insurance after I break my leg but before I go to the hospital.
posted by a robot made out of meat at 6:48 AM on July 29, 2011 [1 favorite]


I have a benign fatty tumor and have had it for decades. My doctor says to do nothing. It causes no pain or discomfort. He looks at it every year and there has been no change. I am not aware that it is there unless I hold a mirror to see it.
posted by JayRwv at 7:08 AM on July 29, 2011


When I worked for an insurance company, and you called me to ask about coverage for this, I would tell you the following:

If the lump appeared before you were insured, most likely it would not be eligible for cover.
If the lump appeared after your coverage began, but recently enough to arouse "suspicion", we would ask for the last five years' worth of notes from your GP, to see if there was any pertinent info about it, and go from there.

And if your GP said it was indeed a lipoma, it would not be covered at all: lipomas are benign and unless it is causing you pain, interfering with your movement somehow, or impinging your line of sight, it would be considered cosmetic surgery and therefore not be covered. If your GP said they didn't know what it was and recommended you have it removed, it would most likely be covered.

If you had it removed prior to your coverage with us, it probably wouldn't affect future coverage, but that's only if it is indeed a lipoma and there wasn't any trouble with it.

Since this condition is self-diagnosed and, thus, does not technically qualify as a "pre-existing condition" since no doctor has made a determination...

This is not true, at least not as far as my experience working in the industry informs me. You must honestly answer when your doctor asks you how long it's been there, and if that date is prior to the beginning of your coverage, it is a pre-existing condition.
posted by Specklet at 9:28 AM on July 29, 2011 [1 favorite]


A couple of points, "Obamacare" changes the way pre-existing conditions are dealt with. In particular:
On June 21, 2010: Adults with pre-existing conditions became eligible to join a temporary high-risk pool, which will be superseded by the health care exchange in 2014.[13][18] To qualify for coverage, applicants must have a pre-existing health condition and have been uninsured for at least the past six months.[19] There is no age requirement.[19] The new program sets premiums as if for a standard population and not for a population with a higher health risk. Allows premiums to vary by age (4:1), geographic area, and family composition. Limit out-of-pocket spending to $5,950 for individuals and $11,900 for families, excluding premiums.
So, you should be able to join the 'temporary high risk pool' to get this covered for a maximum of $5,950. The high risk pools are run by the states, so you'll have to figure out how to get it from your sate government, I guess.

On Jan 1, 2014 regular insurance programs will not be able to discriminate against people for pre-existing conditions.


Another option, if you're not too worried about this, is medical tourism. If you're going to pay cash, it may be cheaper to fly to Thailand or India and have the work done there for less money, even with the plane ticket factored in.
posted by delmoi at 10:26 AM on July 29, 2011


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