Will my health insurance cost go up if I test positive for an STD?

February 7, 2008 9:04 PM

Can your health insurance company raise your rates when you have a positive STD test? Does this typically happen?

Long story short, I recently had the occasion to need an STD screening really fast, like by-the-end-of-the-day-please fast (basically I had another date with the um... relevant person and I wanted to be able to say something concrete about the situation instead of just general ickyness).

I anticipated that I'd end up at a planned parenthood or something, but it turned out that the only thing I could find near my work was an express testing service that sends you straight to a lab for all the screenings, no doctor consult or anything. When I asked the guy on the phone about whether they would take insurance, he went off unprovoked about how messed up health care is in this country, and I COULD tell my insurance, but they'd probably double my premiums if I tested positive because they would consider me high risk, and "it's not fair, but that's how it is."

Is this true? I have health insurance through work, and I never had an entrance physical or anything like that, I just got the standard rate for a person of my general demographic characteristics.

The whole ordeal just kind of smelled funny. The price for the lab work was pretty expensive, but not beyond my means, so I just paid for it. I'm OK with the idea that I got ripped off this time; I did need the service, it didn't break the bank, whatever. But I'm curious if they guy had a point or was just completely full of it.

Web searching reveals nothing helpful, at least using the search strings I could think of.

posted by anonymous to health & fitness (15 answers total)

AFAIK, the guy's full of it. If you were on an individual plan, I dunno - could be. But a group plan through work? No. Your rates wouldn't go up.
posted by rtha at 9:16 PM on February 7, 2008

Their reimbursement from the insurance company is probably less than what they would prefer to charge you out-of-pocket. However, if they refuse your insurance, they are in violation of their contract with that health insurer, and may lose their ability to collect from that insurer on any bills in the future.
posted by ikkyu2 at 9:37 PM on February 7, 2008

Yeah, sounds like the dude was trying to pressure you into opting out of insurance to increase their revenue. My mom's a nurse and she's told me stories about labs and doctor's offices getting paid less by insurance companies than the test should cost to cover their expenses (plus profit, I would expect).

I think this is because insurance companies tend to set rates for different things universally, assuming various costs to the provider that might not apply depending on the situation, or they set rates that are just not realistic. I may be completely off on this, mind you, so feel free to disregard my theorizing about the intricate and opaque inner workings of health insurance :).
posted by MadamM at 9:44 PM on February 7, 2008

Insurance companies negotiate lower rates than the cash rate with their providers in exchange for the promise of steering patients to the provider. While you can actually negotiate with a provider, you don't have the leverage of the insurance company. I suppose that on the less costly procedures, such a labs, they probably get a few people suckered in by this logic.

But you don't have much to worry about by having insurance cover things like this, unless you somehow find yourself needing individual coverage in the future (you become self employed). Then an insurer could potentially deny you specific coverage relating to an STD diagnosis based on pre-existing condition clauses. Group medical plans generally offer a waiver of the pre-existing condition clause if you have previous uninterupted coverage. Individual plans vary by carrier.
posted by uaudio at 10:21 PM on February 7, 2008

I know several women who've been denied individual insurance because they were diagnosed with HPV (gential warts virus)
posted by fshgrl at 10:36 PM on February 7, 2008

In HPV's specific case, may that be because it can cause cervical cancer?
posted by disillusioned at 11:43 PM on February 7, 2008

If you had had a private policy, then, yes, the insurer can jack your rates for a positive screen...or any other reason, frankly. Or, they could simply elect to drop you completely or attach a rider excluding coverage for any std-related condition.

As far as your work policy goes, I don't think the insurer can single you out for a specific rate increase. They can, and probably would, increase the cost across-the-board for your employer. Your claims (and your co-worker's claims) have that effect en-masse.

Could it be that this particular "express" service isn't in-network for your work-based plan? It could also be that this service doesn't take insurance at all.
posted by Thorzdad at 4:08 AM on February 8, 2008

If you have a group plan, check to see if you can still submit your claim for at least a partial reimbursement to you. You would fill out a claim form from the insurance company, attach a copy of the form that the lab should have given you with the procedure codes and the cost that you incurred, as well as documentation that you paid for the services out of pocket. Turn all of this in to the insurance company.

They will look at the entire amount you paid, adjust it for their "allowed amount" for those services, apply the deductible (if applicable) and co-pay expenses, and send you a check for the remainder. If nothing else, this would give you credit towards your deductible this plan year (if it was an eligible medical expense).

If you have a group plan, no, your rates would not go up. I cannot comment on individual plans.
posted by jeanmari at 5:22 AM on February 8, 2008

BTW, regarding your medical claims increasing the costs for your employer:

Your individual claims would not (should not!) be reported to your employer. All of this information about claims and costs is aggregated due to privacy of health care information issues. Your employer is not going to get hit with a premium increase because of one person's STD lab test claims. They'll get an increase because the amount of claims for all employees have gone up overall, or the insurance company decides they need more reserves, or the cost of stop loss insurance has increased, or the contract is being renegotiated in a month that ends in "y". (I used to negotiate the insurance contracts for my large employer. I'm not a fan of insurance companies.)
posted by jeanmari at 5:29 AM on February 8, 2008

I know several women who've been denied individual insurance because they were diagnosed with HPV (gential warts virus)
posted by fshgrl 7 hours ago [+]

In HPV's specific case, may that be because it can cause cervical cancer?
posted by disillusioned Almost 6 hours ago [+]

For individual policies, they might have been denied for any pre-existing condition, and HPV happened to be it in these cases. Or they may find an insurer willing to cover them for anything except treatment for HPV.

In the U.S., you usually can't be denied coverage for a pre-existing condition unless you've been without coverage for a specified period beforehand (60 days, 90 days).
posted by rtha at 5:48 AM on February 8, 2008

In the U.S., you usually can't be denied coverage for a pre-existing condition unless you've been without coverage for a specified period beforehand (60 days, 90 days).

This is only true if you are migrating from a group plan to another group plan. If you are moving from a group plan to an individual (private) plan, all pre-existing conditions can, and will, be considered and you can be denied coverage.
posted by Thorzdad at 6:43 AM on February 8, 2008

If you are moving from a group plan to an individual (private) plan, all pre-existing conditions can, and will, be considered and you can be denied coverage.

Ah yes - true. Sorry to have left that out - it's hard to keep track of all of the fuckedupedness that is the U.S. healthcare system!
posted by rtha at 7:10 AM on February 8, 2008

I hardly know what I'm talk about here, but in addition to what people said above, your insurance might not have covered the tests anyway. For starters, they weren't ordered by a doctor. Also, same day STD results -- at least in your case -- are hardly medically necessary, and you paid a premium for it.

It all depends on your plan.
posted by sbutler at 7:57 AM on February 8, 2008

This is only true if you are migrating from a group plan to another group plan. If you are moving from a group plan to an individual (private) plan, all pre-existing conditions can, and will, be considered and you can be denied coverage.

Well, to be totally accurate, that's not true in every state. There's no such thing as the U.S. health care system; there's 51 different health care systems with different rules and laws and protections. Could be that the OP or other people are living in states that force insurance companies to sell all of the individual plans they offer to anyone who is willing to pay (this is true in Massachusetts, Maine, New Jersey, New York, and Vermont). A whole bunch of other states have at least one insurance company, usually the Blue Cross-Blue Shield affiliate, who is forced to sell a standardized policy to anyone who asks. Many states require some or all insurance companies to sell policies to anyone who is HIPAA-eligible, which involves having been covered by an employer plan then exhausted your COBRA. Of course, almost no states put limits on what these guaranteed-issue policies can charge, so it may be something of an illusion to say you can buy insurance in the individual market if all you can get is a policy that costs $5,000 a month.

The upshot is that anyone trying to figure out exactly how they can get screwed in the insurance market needs to check out their state's laws. Group health insurance through your employer is pretty much the only situation in which national protections apply. If the OP has a group policy through their work, though, they are protected from rate increases based on a single claim, just as jeanmari points out.
posted by iminurmefi at 8:02 AM on February 8, 2008

I put down that I'd had two questionable pap smears on my insurance form (this was a good 10 years ago) within the past 3 years, and that alone triggered me having to get a full physical, blood work, tested for drugs and STD tests at one of my previous jobs (this was in Texas). After all was said and done, I was pronounced perfectly healthy, but the company still deemed me "high risk" and raised my deductible and forced me to get additional screenings every 6 months for two years. On my dime, too. And this was company-provided insurance.

I'm guessing anything that comes up STD-wise that isn't immediately treatable with antibiotics (which is most of them) is considered a pre-existing condition and also a disease that will require maintenance treatment, similar to asthma and diabetes. It won't kill you, but you may need medical procedures and maintenance medication; on the flip side, though, not disclosing it may make the the insurance company refuse to pay for such treatments if and when they arise.

Our health care system is designed to deny you coverage more than provide it these days.

Note: Not a doctor, but definitely have dealt with this on a minor level first-hand. Things may have changed, but I doubt it's for the better. Every provider is different, though.
posted by Unicorn on the cob at 10:16 AM on February 8, 2008