Is it safe to use my current medical benefits while applying for individual health insurance?

January 10, 2012 7:48 PM

I'm in the middle of applying for individual health coverage in California and haven't been approved or rejected yet. Is it safe to use my current medical benefits, and get diagnosed, while applying for individual health insurance, or will they reject me?

Please help me navigate the world of independent medical insurance in California.

I recently quit my job and am working as a freelancer, and my old job's (great) medical benefits extend to, and end on, February 29th. This is my first time applying for independent medical insurance. I applied at ehealthinsurance (Aetna policy) and it said they'd contact me about approval in a few days.

While my old job's benefits are still active, I want to see a psychiatrist for ADD. Those benefits cover unlimited mental health visits, but in order for insurance to work, I must be diagnosed with something. So I will have that on my medical record. I visited a psychologist in the last 2 years, and though I'm not sure what he diagnosed me with, I have that on my record as well.

Let's say that Aetna approves me in the next few days. If I see a psychiatrist a week from now (and he diagnoses me with something and/or prescribes me meds), will Aetna withdraw my policy? Is going to see the psych now a bad move on my part?

posted by elif to Health & Fitness (2 answers total)

I am not an insurance specialist but I am a freelancer with pre-existing conditions (migraines among others) who has switched health insurance a number of times and my advice is to not give your new potential insurer any reason whatsoever to deny you or hit you with astronomical rates. The insurance world is crazy and unpredictable and unless you're dying* I'd hold off on seeing a doctor for anything until you're covered under a new policy.

I have a friend who was in a similar situation to yours and she had a yearly gyno exam that came back with results suggesting a follow-up test. The follow-up test turned out fine but her new insurance company deemed her situation a pre-existing condition and refused to cover anything gynecologically related for some set period of time.

Point being you can't rely on insurance companies to use common sense when determining coverage policies. Don't risk it.

*Please go to the doctor if you're dying.
posted by hapax_legomenon at 9:47 PM on January 10, 2012

I too am a freelancer. It might be a state-by-state thing, but I was under the impression that as long as there was no lapse in coverage (and at least in New York State that can be as many as 60 days without coverage) you cannot be denied a claim on the grounds of a pre-existing condition*. Your current insurer should be able to give you a "certificate of credible coverage" when you leave, that should prevent all of this falderal with the new insurance.

*doesn't mean they won't try. I had to call no less than 15 times to get them to pay for a yearly physical just after I got on my current plan. They tried to bill be $3000, I told them that would not happen and made a lot of noise, and they eventually backed down when I threatened legal action.
posted by aloiv2 at 8:40 AM on January 11, 2012