Depressed and without health insurance
January 5, 2010 9:24 AM   Subscribe

I don't have health insurance right now, but I do get an allowance through work to go toward a private, individual plan. I haven't purchased a plan quite yet, and I'm wondering if seeing a therapist now might cause problems for me later. I also don't understand how pre-existing conditions are defined when it comes to mental health issues. (I live in Washington state.)

I have seen therapists for depression (and related issues) on and off for the last decade, and the last time I saw a therapist on a regular basis was in the spring of 2007. The therapist I saw at that time was through school, paid through student fees and not health insurance. The last time I took any sort of medication was early 2002. I saw a psychiatrist in 2007, at the request of my therapist, and while we did discuss a possible diagnosis of bipolar disorder, no medication was prescribed. Seeing a psychiatrist was also through school, not a health insurance plan.

Basically, I desperately need to see a therapist right now, but my past issues and experiences suggest that I need to see a fairly expensive therapist. I've found someone who looks to be a great match for me, but even with a sliding scale, it's going to be profoundly expensive. And I'm okay with that, but I have two questions:

1. If I were to find an individual insurance plan in the very near future, how long would I have to wait before I could use it to see a therapist? I know it must depend on the specifics of each plan, but I don't understand whether or not I would be considered to have a pre-existing condition. How long in the past can depression be considered pre-existing? Forever? Does it matter that I saw a therapist through my school, rather than a private therapist paid for by insurance?

2. If I go ahead and see a therapist and pay out of pocket, will that cause problems with finding an individual insurance plan in the near future?
posted by anonymous to Health & Fitness (5 answers total) 2 users marked this as a favorite
Short answer: Yes, depression can count as a pre-existing condition. No, it doesn't matter how long you've had it. No, it doesn't matter who paid for your care in the past. Yes, this could make it difficult to get coverage.

Long answer: Common waiting periods for pre-existing conditions are 90 to 180 days, assuming you can get coverage at all. That will depend at least in part on whether your plan provides coverage for psychological health issues. Not all do. My last individual plan didn't. Clearly, you want coverage for that, given your situtation, but that automatically puts you in a more expensive category of plan.

The means by which you procured your health care, psychological or otherwise, is largely irrelevant in the pre-existing condition analysis. All they care about is 1) whether or not you have a current diagnosis which would be covered under their plan, and 2) whether or not you have coverage currently in place which covers said diagnosis.

Note that "pre-existing condition" only contains one temporal indicator, i.e. all that matters is whether it's been diagnosed before coverage is enacted. An existing congenital condition which has been unsymptomatic for decades but suddenly requires surgery could easily qualify as a pre-existing condition.
posted by valkyryn at 10:04 AM on January 5, 2010

I'm going to be contrary here and suggest that you set aside this question for now. I'm really worried that you seem to be hesitant to get the help you need because you're concerned about what a hypothetical insurance company might think at some random point in the future.

Will it or won't it? It might or it might not. Maybe. It depends. Mental health parity laws went into effect on 1/1/10, and we still don't know how insurance companies are going to react. Health care could be completely reformed by then. Or the zombie apocalypse could have happened. There's no way to know, and little point fretting over it.

Please get that help. Get the prescription you need, if you need one. Be well. Cross the "pre-existing condition" bridge when (if) you get to it.
posted by ErikaB at 12:10 PM on January 5, 2010

I have not been successful finding private insurance with depression in my medical records. I was never hospitalized, just received therapy and currently take a common anti-depressant.

For example, one large insurer told me I had to be symptom and treatment free for 5 years before they would consider insuring me. As my depression is managed through therapy and medication, I can't see that happening in the near future. My hope is that once health reform passes, an insurance company will have to take me, but I am concerned about at what cost.

If you need treatment, you should get it, but you should be aware of the ramifications.
posted by cecic at 1:03 PM on January 5, 2010

Go ahead and get insurance -- or at least apply for it -- now. Get an application (maybe just download one from an insurer's web site) and see what questions are on the application. Answer them honestly.
posted by amtho at 1:08 PM on January 5, 2010

My SO talked me into to seeing a therapist, actually a woman who was a certified family councelor. She was not licensed to prescribe medication and I was not seeing her for any specifically diagnosed problem (ie I was not depressed, etc.) it was just a bi-monthly someone to talk to.

I was unable to find private health insuranced based on the fact that I saw this woman for about a year, even though I was never diagnosed with anything and never recieved any prescriptions. This was in CA around 2005. Made things pretty annoying when I was unemployed.
posted by buzzkillington at 9:02 PM on January 5, 2010

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