What should I tell him?
October 17, 2006 9:38 PM Subscribe
I may have health information about someone that I don't want to have. Should I disclose? How on earth do I approach it?
I have been dating somebody wonderful for several months. He's sweet and kind and good.
There were some things about him that concerned me somewhat -- not in a relationship-threatening way, just in a "huh, I wonder what that's about?" kind of way. He takes very small steps, particularly in the morning. He sometimes has this weird total lack of expression on his face. He can be quite clumsy. He's tired all the time.
He's also quite concerned about his health lately. He feels like something's wrong.
Someone reliable (sorry to be vague, editing out identifying information -- trust me, they're reliable) has told me that these are all potential signs of early parkinson's disease.
This person is completely without health insurance.
Two issues: I know I should tell him to get to a doctor. My concern is, if this is what it is, and it is diagnosed before he has insurance, he could have enormous trouble getting covered.
But how do I tell him -- go get insurance, and THEN get to a doctor? This will represent a significant financial hardship to him, the getting of insurance.
I am very reluctant to tell him of my suspicion (I pray pray pray to god it's not true) not only because it's terrifying, but because he is a very...frightenable person in matters like this. I really don't want to needlessly freak him out. And I also, selfishly, don't want to come across as a paranoid freak.
What should I do? Tell him? How?
I have been dating somebody wonderful for several months. He's sweet and kind and good.
There were some things about him that concerned me somewhat -- not in a relationship-threatening way, just in a "huh, I wonder what that's about?" kind of way. He takes very small steps, particularly in the morning. He sometimes has this weird total lack of expression on his face. He can be quite clumsy. He's tired all the time.
He's also quite concerned about his health lately. He feels like something's wrong.
Someone reliable (sorry to be vague, editing out identifying information -- trust me, they're reliable) has told me that these are all potential signs of early parkinson's disease.
This person is completely without health insurance.
Two issues: I know I should tell him to get to a doctor. My concern is, if this is what it is, and it is diagnosed before he has insurance, he could have enormous trouble getting covered.
But how do I tell him -- go get insurance, and THEN get to a doctor? This will represent a significant financial hardship to him, the getting of insurance.
I am very reluctant to tell him of my suspicion (I pray pray pray to god it's not true) not only because it's terrifying, but because he is a very...frightenable person in matters like this. I really don't want to needlessly freak him out. And I also, selfishly, don't want to come across as a paranoid freak.
What should I do? Tell him? How?
I think you're mistaken. You don't have "health information" about someone, you have "a health-related suspicion" about them. Adjust your expectations of your behavior (and your panic level) appropriately.
posted by majick at 9:52 PM on October 17, 2006
posted by majick at 9:52 PM on October 17, 2006
when i read the list of symptoms, i also thought it sounds like it could be parkinsons.
i am not an MD, but i am a scientist who works with MDs so i have seen how they respond when they inadvertantly discover a potential neurological problem: they calmly tell the person exactly what they are seeing and what it might mean and encourage them to seek further medical assistance.
i think you should do the same for your friend.
best wishes and i hope it turns out to be nothing.
posted by tabulem at 10:00 PM on October 17, 2006
i am not an MD, but i am a scientist who works with MDs so i have seen how they respond when they inadvertantly discover a potential neurological problem: they calmly tell the person exactly what they are seeing and what it might mean and encourage them to seek further medical assistance.
i think you should do the same for your friend.
best wishes and i hope it turns out to be nothing.
posted by tabulem at 10:00 PM on October 17, 2006
If he were to obtain health insurance directly himself, he'd certainly have to go through a screening interview to determine any existing health conditions (this screening process is called "underwriting"). Now if you can pickup on his symptoms of Parkinson's, then a professional underwriter likely would too. So I'll let someone else suggest a way to communicate this to your friend, but in the meantime realize that issue of insurance might be secondary because it's a longshot anyway.
posted by randomstriker at 10:06 PM on October 17, 2006
posted by randomstriker at 10:06 PM on October 17, 2006
good point randomstriker. however it sounds like early stages of parkinsons (if that's what it even is) and he could probably hide it at this point, if he knew what he had to hide.
ethically perhaps the right thing to do is get the insurance *before* any further diagnosis, because at this stage he can legitimately state that he has no known major health problems.
posted by tabulem at 10:11 PM on October 17, 2006
ethically perhaps the right thing to do is get the insurance *before* any further diagnosis, because at this stage he can legitimately state that he has no known major health problems.
posted by tabulem at 10:11 PM on October 17, 2006
Tell him what you suspect and why he should get insurance. You'll frighten him much more with vague insinuations about getting insurance if you don't tell him the reasons.
posted by Krrrlson at 10:16 PM on October 17, 2006
posted by Krrrlson at 10:16 PM on October 17, 2006
As unpleasant as it may be, I find the easy way with most difficult things is to tell the truth to the person concerned and let them make their own decision. That is, I agree with what those smart people up there said.
posted by b33j at 10:23 PM on October 17, 2006
posted by b33j at 10:23 PM on October 17, 2006
Knowingly hiding a condition from an insurer is a form of insurance fraud, and insurers are becoming very good at investigating suspicious cases. Especially when a condition is "diagnosed" shortly after coverage begins. In cases where it's worth their while, i.e. chronic conditions which require expensive ongoing care (like Parkinson's), they will really dig deep for incriminating evidence. Moreover many insurance contracts have escape clauses that anticipate situations exactly like this.
I am not suggesting that your friend shouldn't try to obtain insurance. I am suggesting that he shouldn't have high expectations about succeeding, given that a full doctor's exam is sometimes part of the underwriting process. I am also suggesting that he should not actively conceal his condition, as that may risk a lawsuit later on.
Well, I may as well stop dancing around the subject and just say what I was implying all along: for a serious, debilitating condition such as Parkinson's, obtaining a diagnosis and then proper treatment should be the first, immediate concern. The financial issues are secondary, however burdensome they may be. Don't bother trying to game any insurers, because they are pros at this and know all the tricks people try and pull.
posted by randomstriker at 10:39 PM on October 17, 2006 [1 favorite]
I am not suggesting that your friend shouldn't try to obtain insurance. I am suggesting that he shouldn't have high expectations about succeeding, given that a full doctor's exam is sometimes part of the underwriting process. I am also suggesting that he should not actively conceal his condition, as that may risk a lawsuit later on.
Well, I may as well stop dancing around the subject and just say what I was implying all along: for a serious, debilitating condition such as Parkinson's, obtaining a diagnosis and then proper treatment should be the first, immediate concern. The financial issues are secondary, however burdensome they may be. Don't bother trying to game any insurers, because they are pros at this and know all the tricks people try and pull.
posted by randomstriker at 10:39 PM on October 17, 2006 [1 favorite]
[ I'm assuming you live in the United States. ]
You should be trying to convince him that he needs health insurance, regardless of whether he has any signs of any condition. Even if he's perfectly healthy, not being insured is one of those things that you shouldn't play around with. So even if you never noticed these signs, and never had reason to believe that they could be signs of early Parkinson's, you should try to convince him to get insurance. It's Just The Right Thing™.
Now the secondary questions here seem to be whether or not you should tell him about your suspicions, and whether he should knowingly try to play the insurance screenings in such a way as to de-emphasize these conditions or not. As others have already said, that consitutes fraud and could potentially make things a lot worse, so that isn't a good road to go down either. However, it also shouldn't be used as an excuse to not apply for the insurance, since even if they found a pre-existing condition he'd still be a lot better off with partial coverage than no coverage.
I guess what I'm getting at is that the worst possible thing that could happen would be to not even try to get insurance, and not even see the doctor because of having no insurance.
posted by Rhomboid at 11:00 PM on October 17, 2006
You should be trying to convince him that he needs health insurance, regardless of whether he has any signs of any condition. Even if he's perfectly healthy, not being insured is one of those things that you shouldn't play around with. So even if you never noticed these signs, and never had reason to believe that they could be signs of early Parkinson's, you should try to convince him to get insurance. It's Just The Right Thing™.
Now the secondary questions here seem to be whether or not you should tell him about your suspicions, and whether he should knowingly try to play the insurance screenings in such a way as to de-emphasize these conditions or not. As others have already said, that consitutes fraud and could potentially make things a lot worse, so that isn't a good road to go down either. However, it also shouldn't be used as an excuse to not apply for the insurance, since even if they found a pre-existing condition he'd still be a lot better off with partial coverage than no coverage.
I guess what I'm getting at is that the worst possible thing that could happen would be to not even try to get insurance, and not even see the doctor because of having no insurance.
posted by Rhomboid at 11:00 PM on October 17, 2006
If he is so broke that he can't afford insurance and he doesn't qualify for it through his job, your boyfriend may be eligible for your state's Medicare program (assuming you're in the US).
There's information about the federal program here.
Many states go beyond the minimum offerings of Medicaid, however, and it's worth investigating whether he would be able to get assistance through a state program.
I have a very good friend whose income is low enough that she qualifies for the Oregon Health Plan, for example. Staying enrolled requires a lot of bureaucratic hoop jumping, but without the plan her several major medical issues would go untreated.
A good place to start this inquiry would be with your county health department. If that doesn't get you anywhere, try your state health department. If one low-level bureaucrat is unhelpful, don't give up. Sometimes you just have to ask the right person to get the answer you want.
posted by croutonsupafreak at 11:20 PM on October 17, 2006
There's information about the federal program here.
Many states go beyond the minimum offerings of Medicaid, however, and it's worth investigating whether he would be able to get assistance through a state program.
I have a very good friend whose income is low enough that she qualifies for the Oregon Health Plan, for example. Staying enrolled requires a lot of bureaucratic hoop jumping, but without the plan her several major medical issues would go untreated.
A good place to start this inquiry would be with your county health department. If that doesn't get you anywhere, try your state health department. If one low-level bureaucrat is unhelpful, don't give up. Sometimes you just have to ask the right person to get the answer you want.
posted by croutonsupafreak at 11:20 PM on October 17, 2006
1. Tell him your observations and your concerns about what they MIGHT indicate. How he (over?)reacts is up to him, but if there's a chance that he could already be losing time to a progressive illness, you'll never forgive yourself if you don't give him that chance to decide whether to seek diagnosis/treatment now.
2. Independent of the outcome of that situation, he needs insurance if at all possible. Even if this set of symptoms turns out to be nothing, there will be a day soon when there is genuine need either by disease or injury. Help him to apply.
3. If he does have Parkinsons or gets turned down for some other reason, don't give up on hope for health coverage. Being turned down for insurance is usually the first step in becoming eligible for one's state high risk pool.
posted by nakedcodemonkey at 11:37 PM on October 17, 2006
2. Independent of the outcome of that situation, he needs insurance if at all possible. Even if this set of symptoms turns out to be nothing, there will be a day soon when there is genuine need either by disease or injury. Help him to apply.
3. If he does have Parkinsons or gets turned down for some other reason, don't give up on hope for health coverage. Being turned down for insurance is usually the first step in becoming eligible for one's state high risk pool.
posted by nakedcodemonkey at 11:37 PM on October 17, 2006
Boy, this is a tough question on a lot of levels, and the inability to get more information makes it nearly impossible to know how to advise you.
1. It's really hard to diagnose early Parkinson's disease - I know, I've done it. I've also misdiagnosed it, and diagnosed it where it didn't exist. And hey, I'm a board-certified neurologist. I can think of at least 10 other ailments that fit the symptoms you described, a couple of them more likely than PD; and half of them aren't even neurological. *You haven't even taken a history of the illness*, which is fancy doc speak for "remember to talk to the patient." So you can't really know what's going on.
Of course, you say your source is reliable. So I'm assuming you have a friend who's a board-certified neurologist or something, who saw your boyfriend and said "hey look at that, he's got PD." OK, even though your friend didn't take a history either, let's assume he's right. So let's go from there.
2. It's hard to know where you are! Are you in the US? Because a lot of folks in the US who are of the age to get PD are coming up on the age where they get this nifty national healthcare benefit, it's called Medicare. I'm going to come out with a statistical argument here and say that the further away from Medicare age your boyfriend is, the less likely your diagnosis is to be correct.
3. PD treatment alleviates the symptoms; it's pretty clear that either it *doesn't* alter the natural history of the disease, or if it does, it alters it *very little* (and possibly accelerating it, not retarding it, although that's hotly debated.) So if you're right, there's no harm in waiting a little bit. (If you're not right, then maybe there's something else wrong which really does need to be investigated.) It's not like cancer where early detection means a chance for cure; it's the exact opposite of that situation.
Which brings up the next point..
4. PD can be disabling. We have a benefit for disabled people in this country; it's called SSI. If he's worked and paid into Social Security, and he's disabled by illness, he's entitled to health care and maybe a stipend.
If he's not disabled? So nu? Why worry? Maybe it won't get any worse until he's 65.
5. How are you going to effect any change here without leveling with him about it? Do you think anything good can happen without his consent and cooperation? The days when master diagnosticians (like you, anonymous; or me) could "pull a fast one" on patients, getting them into treatment without them even knowing what hit them - those days are long gone. These are his interests and his issues and we've only heard about your concerns. Those things all have to match and meet up and get dovetailed before you're going to make any headway on these problems.
6. Other people have said, "He needs insurance if at all possible." That's a tall order for people who aren't getting it through their work. The first step - before a doc officially diagnoses him, for obvious "pre-existing condition" reasons, might be to talk to a knowledgeable medical social worker, even if it's just on the phone for 10 minutes. Your local hospital probably has one or more. They're *really good* at this stuff - definitely worth, say, lunch at a nice restaurant of their own choosing.
posted by ikkyu2 at 2:29 AM on October 18, 2006 [6 favorites]
1. It's really hard to diagnose early Parkinson's disease - I know, I've done it. I've also misdiagnosed it, and diagnosed it where it didn't exist. And hey, I'm a board-certified neurologist. I can think of at least 10 other ailments that fit the symptoms you described, a couple of them more likely than PD; and half of them aren't even neurological. *You haven't even taken a history of the illness*, which is fancy doc speak for "remember to talk to the patient." So you can't really know what's going on.
Of course, you say your source is reliable. So I'm assuming you have a friend who's a board-certified neurologist or something, who saw your boyfriend and said "hey look at that, he's got PD." OK, even though your friend didn't take a history either, let's assume he's right. So let's go from there.
2. It's hard to know where you are! Are you in the US? Because a lot of folks in the US who are of the age to get PD are coming up on the age where they get this nifty national healthcare benefit, it's called Medicare. I'm going to come out with a statistical argument here and say that the further away from Medicare age your boyfriend is, the less likely your diagnosis is to be correct.
3. PD treatment alleviates the symptoms; it's pretty clear that either it *doesn't* alter the natural history of the disease, or if it does, it alters it *very little* (and possibly accelerating it, not retarding it, although that's hotly debated.) So if you're right, there's no harm in waiting a little bit. (If you're not right, then maybe there's something else wrong which really does need to be investigated.) It's not like cancer where early detection means a chance for cure; it's the exact opposite of that situation.
Which brings up the next point..
4. PD can be disabling. We have a benefit for disabled people in this country; it's called SSI. If he's worked and paid into Social Security, and he's disabled by illness, he's entitled to health care and maybe a stipend.
If he's not disabled? So nu? Why worry? Maybe it won't get any worse until he's 65.
5. How are you going to effect any change here without leveling with him about it? Do you think anything good can happen without his consent and cooperation? The days when master diagnosticians (like you, anonymous; or me) could "pull a fast one" on patients, getting them into treatment without them even knowing what hit them - those days are long gone. These are his interests and his issues and we've only heard about your concerns. Those things all have to match and meet up and get dovetailed before you're going to make any headway on these problems.
6. Other people have said, "He needs insurance if at all possible." That's a tall order for people who aren't getting it through their work. The first step - before a doc officially diagnoses him, for obvious "pre-existing condition" reasons, might be to talk to a knowledgeable medical social worker, even if it's just on the phone for 10 minutes. Your local hospital probably has one or more. They're *really good* at this stuff - definitely worth, say, lunch at a nice restaurant of their own choosing.
posted by ikkyu2 at 2:29 AM on October 18, 2006 [6 favorites]
Have you considered suggesting that your friend move from the US and gain citizenship in a more enlightened country that provides universal health care?
posted by crunchland at 6:17 AM on October 18, 2006
posted by crunchland at 6:17 AM on October 18, 2006
The financial issues are secondary, however burdensome they may be.
Wow. I'm guessing you've never had to worry about money. Lucky you.
To the poster: Tell him your suspicions (emphasizing ikkyu2's point that there are many other possibilities) and urge him to try to get insurance. If he can't, he can't, but it's sure worth the shot. (And tell your congressman to start working on getting this country out of its impossible healthcare situation.)
posted by languagehat at 6:49 AM on October 18, 2006
Wow. I'm guessing you've never had to worry about money. Lucky you.
To the poster: Tell him your suspicions (emphasizing ikkyu2's point that there are many other possibilities) and urge him to try to get insurance. If he can't, he can't, but it's sure worth the shot. (And tell your congressman to start working on getting this country out of its impossible healthcare situation.)
posted by languagehat at 6:49 AM on October 18, 2006
I can't and won't comment on whether signing up for health insurance now would constitute fraud. But I would caution you that individual health plans often include a reduced-benefit waiting period in an effort to weed-out the self-selection problem, and they may deny coverage if you should have known of the pre-existing condition before you signed up for it.
However, many states have high risk health insurance pools that do not discriminate based on a pre-existing condition. You pay about what you would under a COBRA plan - not cheap by any means but always a better option than self-pay given that you are by definition going to be seeking lots of medical treatment.
posted by Saucy Intruder at 6:56 AM on October 18, 2006
However, many states have high risk health insurance pools that do not discriminate based on a pre-existing condition. You pay about what you would under a COBRA plan - not cheap by any means but always a better option than self-pay given that you are by definition going to be seeking lots of medical treatment.
posted by Saucy Intruder at 6:56 AM on October 18, 2006
Have you considered suggesting that your friend move from the US and gain citizenship in a more enlightened country that provides universal health care?
It takes in the neighbourhood of five years to obtain visas and then get the residency requirements to obtain Canadian citizenship, if that's the enlightened country you're thinking of. And if you have a major pre-existing illness that's going to cost our medical system a zillion dollars to treat, they won't let you in.
posted by jacquilynne at 8:18 AM on October 18, 2006
It takes in the neighbourhood of five years to obtain visas and then get the residency requirements to obtain Canadian citizenship, if that's the enlightened country you're thinking of. And if you have a major pre-existing illness that's going to cost our medical system a zillion dollars to treat, they won't let you in.
posted by jacquilynne at 8:18 AM on October 18, 2006
Wow. I'm guessing you've never had to worry about money. Lucky you.
Wow. You're making a lot of assumptions about me. I am not well off by any means, and it is precisely because I've had to deal a crippling condition that I consider the money issues to be secondary. When your health is at stake, it shifts your perspective about what really matters. Let me reiterate again: focus first on getting diagnosed and treated / cared for. The money issues will be resolved one way or another -- as others have pointed out there are backup options to private insurance.
I can't and won't comment on whether signing up for health insurance now would constitute fraud.
Perhaps I wasn't being clear. If the person in question can afford the insurance, he should attempt to obtain it. Pursuing insurance when you have an existing condition is not fraudulent. It's fraud if you conceal the condition (or signs of it) when required to disclose it.
posted by randomstriker at 11:11 AM on October 18, 2006
Wow. You're making a lot of assumptions about me. I am not well off by any means, and it is precisely because I've had to deal a crippling condition that I consider the money issues to be secondary. When your health is at stake, it shifts your perspective about what really matters. Let me reiterate again: focus first on getting diagnosed and treated / cared for. The money issues will be resolved one way or another -- as others have pointed out there are backup options to private insurance.
I can't and won't comment on whether signing up for health insurance now would constitute fraud.
Perhaps I wasn't being clear. If the person in question can afford the insurance, he should attempt to obtain it. Pursuing insurance when you have an existing condition is not fraudulent. It's fraud if you conceal the condition (or signs of it) when required to disclose it.
posted by randomstriker at 11:11 AM on October 18, 2006
Wow. I'm guessing you've never had to worry about money. Lucky you.
when you're dealing with life-threatening diseases, there are, in fact, ways to get treatment and deal with finances later. I was treated for cancer when I was uninsured - not the best treatment available, but I got the basics.
Parkinson's, though, is basically untreatable, so getting a diagnosis would be more useful toward SSI than anything, if he's unable to work due to the symptoms. My mom has MS, which is similarly not all that treatable - the diagnosis provided a small level of comfort that she wasn't just going crazy or something, but at the end of the day, the most useful aspect is that the gov covers many of her needs now.
Though, I have to say, it's very possible he's already aware of this kind of possibility. I am constantly paranoid that I've got MS, whenever I stumble over a word or do something clumsy. It wouldn't help me to have a friend worried over it too... until the symptoms are actually interfering with life, maybe it's ok to just take them for what they are now, and not get stuck in what they may lead to later.
posted by mdn at 9:14 AM on October 19, 2006
when you're dealing with life-threatening diseases, there are, in fact, ways to get treatment and deal with finances later. I was treated for cancer when I was uninsured - not the best treatment available, but I got the basics.
Parkinson's, though, is basically untreatable, so getting a diagnosis would be more useful toward SSI than anything, if he's unable to work due to the symptoms. My mom has MS, which is similarly not all that treatable - the diagnosis provided a small level of comfort that she wasn't just going crazy or something, but at the end of the day, the most useful aspect is that the gov covers many of her needs now.
Though, I have to say, it's very possible he's already aware of this kind of possibility. I am constantly paranoid that I've got MS, whenever I stumble over a word or do something clumsy. It wouldn't help me to have a friend worried over it too... until the symptoms are actually interfering with life, maybe it's ok to just take them for what they are now, and not get stuck in what they may lead to later.
posted by mdn at 9:14 AM on October 19, 2006
Parkinson's, though, is basically untreatable
Completely inaccurate. There are quite a few different highly effective therapies for PD.
posted by ikkyu2 at 7:53 PM on October 29, 2006
Completely inaccurate. There are quite a few different highly effective therapies for PD.
posted by ikkyu2 at 7:53 PM on October 29, 2006
This thread is closed to new comments.
If it is a matter of finance...can he move somewhere where he can be covered by county or state insurance?
If he doesn't want to get the insurance first and wants more of a reason you've brought it up...I'd tell him you have concerns about his health. How? With calm explanations about what symptoms you've seen and the possible reasons for the problem. And a promise to help him explore his options.
posted by ?! at 9:51 PM on October 17, 2006