Can you change insurance plans after an injury is partially diagnosed?

February 4, 2013 8:21 AM

I don't have employer-provided insurance and purchase it directly. Is it possible to increase coverage to deal with a new health issue?

I finally went to the doctor after a few months of shoulder pain; it's some kind of rotator cuff injury. I have a high-deductible (10k) HSA through Blue Cross with only about a thousand in the account. Even an MRI to more fully diagnose it would more than drain the account, and if I had to have surgery, there's no way I could pay for it.
I'm sure the answer is somehow "NO" but could I try and change my coverage now to a conventional health insurance plan? Or if I did would they be likely to charge some exorbitant rate? I can call and ask but don't know if I'd be shooting myself in the foot by pointing it out, and I'm pretty sure the doctor has submitted my visit to the insurance company, so they'll know something's up. Don't they have access to my records anyway?
I chose the HSA in the first place because the normal plan is so expensive, but I feel if I could change now it might be worth it, though it would be very difficult to pay for. I'm in my mid 40s so it's not like I won't be having other issues. I feel like it's try and get a new plan or look for another job and hope I can get covered there, I guess.
Stupid U.S. health care system!

posted by anonymous to health & fitness (7 answers total)

You can certainly change policies. However, something like the rotator cuff injury would probably be subject to a policy rider. That is, coverage on treatment for the injury will be disallowed for a given period of time...usually between 6 months and a year.
posted by Thorzdad at 8:33 AM on February 4

Nope, there's generally not going to be any way to do this, at least for the next 10 months. It's unlikely that you'd get charged an exhorbitant rate, it's more likely that they'd just decline coverage altogether or write in a rider that specifically excluded coverage for anything related to your shoulder.

On the upside, starting next January you will be able to move freely between plans in your state's Health Insurance Connector, and plans won't be able to exclude any pre-existing condition or charge you higher rates. I hate to be like "maybe you should just suffer for another 10 months" but realistically if you can't swing it currently you're looking at either waiting until the new year or getting a new job.
posted by iminurmefi at 8:50 AM on February 4

Well... kind of. Thing is, this exactly the sort of moral hazard, i.e., buying health insurance when you're sick, that the system is designed to prevent.

If you had some legitimate reason for changing carriers, e.g., switching jobs, this wouldn't be a problem. Health insurance companies lose/gain sick/healthy customers all the time because of things like this, and it basically comes out in the wash.

But this isn't a legitimate reason. You decided to go for a cheap health plan, and now you've got a loss, and you wish you'd bought more. That sucks, but it was a risk you decided to bear, and you're going to have to deal with it.
posted by valkyryn at 8:59 AM on February 4 [4 favorites]

It's unlikely you will be able to do this - they'll probably exclude coverage for your pre-existing condition. However, you can probably work with the doctor to do a payment plan. My BFF just had surgery on her spine and the doctors all worked with her on a payment plan, so she's paying them off in installments. You can also generally negotiate with hospitals, anesthesiologists, etc. when you have a high-deductible plan or little to no insurance coverage. Just talk to the doc about it and see if they can help you out. And as soon as you can get a better insurance plan, do so.
posted by bedhead at 10:40 AM on February 4

I have a 10k deductible individual insurance policy (not HSA though) with Blue Cross/Blue Shield of Texas. I'm not sure what your experience was, but when I applied for it they asked for all the different things I'd gone to a doctor for in the past 5 years or more -- infections, colds, whatever. Then I had a follow-up phone call from a "doctor" (or so the recording said) in India, who read off questions in a monotone voice and then typed my answers into their system. These were questions like, "So I do not want to upset you but I see you took an antidepressant 5 years ago why and do you feel like killing yourself now." and "When you went to the doctor 4 years ago for a You-Tee-Eye what was the diagnosis and have you recovered yet."

The application's questions, and the weird follow-up questions by phone? Those are designed to weed out exactly what you're hoping to do right now. The idea is you should not have a deductible that is bigger than what you can pay. Insurance is to protect you against financial losses that you cannot afford, and that must've been something less than the 10k deductible.

If it were me, I'd ask the doctor if this is the type of thing that an wait. Are there some exercises you can do to not lose movement in the shoulder while you wait? If the doctor says it cannot wait, I'd borrow the 10k from the bank, or against the house, or from family or friends, or by seriously selling things off and cutting costs.
posted by Houstonian at 7:57 PM on February 4

If it turns out that you do need surgery and can't wait, make sure you talk to the clinic/hospital ahead of time. You should benefit from the lower negotiated rate of the insurance company (which will help) and you can probably work out a payment plan for the rest.
posted by metahawk at 9:41 PM on February 4

I hate to say it, but this is the cause of the health crisis.

You can change your policy but it doesn't mean you will 1) get denied and 2) get approved with a huge rate. PPO is always your best bet to pay up front. Otherwise, wait until next open enrollment and change there. It will be a year. The other option is yes, find another job with better insurance.

Never, ever think you're not going to get sick and pick the cheapest insurance possible.
posted by stormpooper at 10:23 AM on February 5