Diabolical Medical System From Hell
January 31, 2011 11:09 AM Subscribe
I just got health insurance for the first time in my adult life (thanks a bunch America), through my spouse's company. It seems like fairly robust insurance, and I would love to finally get treatment for my debilitating anxiety and possible ADHD. But I am so fearful of having these things on my medical record and possibly causing future insurance problems, that I am hesitant to make any appointments. Am I justified in these concerns? Are there things I can do to mitigate the repercussions?
From the information I have cobbled together, there would be problems if my spouse and I were no longer on his company insurance, and had to get our own insurance independently. How much of a problem would this likely be? Should I try my hardest to do this all outside of the nice system I suddenly have available to me? I'd love to do some kind of CBT (or similar) therapy, and for once try some medication, but not at the risk of causing permanent problems for myself down the line. Thanks for any ideas or information.
From the information I have cobbled together, there would be problems if my spouse and I were no longer on his company insurance, and had to get our own insurance independently. How much of a problem would this likely be? Should I try my hardest to do this all outside of the nice system I suddenly have available to me? I'd love to do some kind of CBT (or similar) therapy, and for once try some medication, but not at the risk of causing permanent problems for myself down the line. Thanks for any ideas or information.
Prior to the HCR act, I got insurance when you had to report everything. For me, that included smoking, depression treatment, PVC's, BMI, etc. They didn't bat an eye.
Go get help. Getting your issues treated now is way more important than the potential of a health insurance denying you some point in the future.
posted by Mister Fabulous at 11:30 AM on January 31, 2011
Go get help. Getting your issues treated now is way more important than the potential of a health insurance denying you some point in the future.
posted by Mister Fabulous at 11:30 AM on January 31, 2011
I think you should use the insurance! You have it now. God only knows what the health care system in the US will look like next year, never mind five years or ten years from now. And KathrynT is right - continuous coverage is the key. As long as you don't have a gap of more than two months, you are going to be able to get insurance.
OK, let's say you are insuranceless for three months for some reason - you may still be able to get an policy that covers everything EXCEPT your anxiety and ADHD, maybe forever or maybe for the first year you're on the plan.
Or, absolute worst case scenario, you still can't get insurance, but you've made do without it for your whole adult life so far.
USE THE INSURANCE.
posted by mskyle at 11:31 AM on January 31, 2011
OK, let's say you are insuranceless for three months for some reason - you may still be able to get an policy that covers everything EXCEPT your anxiety and ADHD, maybe forever or maybe for the first year you're on the plan.
Or, absolute worst case scenario, you still can't get insurance, but you've made do without it for your whole adult life so far.
USE THE INSURANCE.
posted by mskyle at 11:31 AM on January 31, 2011
I think getting treatment is the best thing you can do for yourself. Especially if what KathrynT said is true about insurance companies not asking about pre-existing conditions as long as you've had continuous coverage.
Because my experience getting individual health insurance (before the changes) was not good. I was flat out denied coverage because I had conditions X and Y (one company didn't like X, another didn't like Y). And I mean, I'm healthy. One of the conditions was more mental-health related, and the other was physical and unpreventable. Finally, after being 5 years beyond conditions X and Y (and 3 years of being uninsured, since I left my full time job) I found insurance. Yay! So it used to be a nightmare for some of us.
So I say: use it if you got it!
posted by iguanapolitico at 11:40 AM on January 31, 2011
Because my experience getting individual health insurance (before the changes) was not good. I was flat out denied coverage because I had conditions X and Y (one company didn't like X, another didn't like Y). And I mean, I'm healthy. One of the conditions was more mental-health related, and the other was physical and unpreventable. Finally, after being 5 years beyond conditions X and Y (and 3 years of being uninsured, since I left my full time job) I found insurance. Yay! So it used to be a nightmare for some of us.
So I say: use it if you got it!
posted by iguanapolitico at 11:40 AM on January 31, 2011
The benefit of getting treatment far, far outweighs the possibility that someone will discover you, like many, many others, suffer from ADHD and anxiety, and that there will be negative repercussions.
posted by theora55 at 11:54 AM on January 31, 2011 [1 favorite]
posted by theora55 at 11:54 AM on January 31, 2011 [1 favorite]
Ask your psych for the most generalized, non-specific diagnosis. If you need meds, there's no way to get around it but to be diagnosed as generalized anxiety, dysthimia, etc. But yes, there is/was good reason for you worry. HCR can be passed but a lot of things dont' become effective utnil 2014. House/Senate are always making admendments to the law. I wouldn't trust the gov. with a ten foot poll. I would be as cautious as you can while still getting what you need.
Ask for the most generalized diagnosis. Not a problem. I've been going through it too.
posted by stormpooper at 11:56 AM on January 31, 2011 [1 favorite]
Ask for the most generalized diagnosis. Not a problem. I've been going through it too.
posted by stormpooper at 11:56 AM on January 31, 2011 [1 favorite]
Use your insurance and get treatment. Incidentally, the HCR bill is not why companies don't ask about pre-existing conditions if you've had continuous coverage; that was already in place prior to the bill being passed. Depending on the condition, many people could still get coverage even with pre-existing conditions, but there were limitations on how much the new insurance company would pay for the pre-existing condition for x amount of time. I had this happen years ago - my new insurance company would pay for everything except my existing condition for 1 year, then they'd cover everything.
Shorter answer: the benefits of getting treatment outweigh the risks of future insurance issues. Go for it.
posted by bedhead at 12:09 PM on January 31, 2011
Shorter answer: the benefits of getting treatment outweigh the risks of future insurance issues. Go for it.
posted by bedhead at 12:09 PM on January 31, 2011
Continuous coverage only means that you can't be outright refused coverage. It does not mean that you will be able to get afford the coverage though.
posted by COD at 12:31 PM on January 31, 2011
posted by COD at 12:31 PM on January 31, 2011
Just adding that while getting health insurance in the future probably won't be impacted, will you be needing to apply for individual life insurance or disability insurance? I just went through the process of applying for disability, and they ask if you've been treated for depression or other mental disorders. In my case, it wasn't a big deal for life insurance, but it was for disability. Evidently depression and some other diagnoses are a big actuarial black mark against you because you're more likely to need disability in the future, no matter how slight the incident/treatment.
posted by ninjakins at 12:32 PM on January 31, 2011 [2 favorites]
posted by ninjakins at 12:32 PM on January 31, 2011 [2 favorites]
Continuous coverage only means that you can't be outright refused coverage. It does not mean that you will be able to afford the coverage though.
This.
The ginormous hole through which insurers will still be able to deny you coverage, without actually denying you.
posted by Thorzdad at 12:52 PM on January 31, 2011 [2 favorites]
This.
The ginormous hole through which insurers will still be able to deny you coverage, without actually denying you.
posted by Thorzdad at 12:52 PM on January 31, 2011 [2 favorites]
COD and Thorzdad, when I applied for my coverage, they asked my age, my gender, and whether or not I smoked. They quoted me a premium based on those factors. After I was excused from the health questionnaire, they confirmed my previous coverage and sold me the policy for exactly the quoted premium. They didn't have an option to jack the premium based on health conditions, because they never asked about them.
posted by KathrynT at 1:26 PM on January 31, 2011
posted by KathrynT at 1:26 PM on January 31, 2011
Forgot to add that when a friend of mine applied for this exact policy back in June, she had to answer all the questions despite having continuous coverage. According to my provider, the changes were enacted in 8/10 as a result of the health care reform legislation.
posted by KathrynT at 1:27 PM on January 31, 2011
posted by KathrynT at 1:27 PM on January 31, 2011
First: get treatment.
Second: there's some big differences in how the latest health care reform law (PPACA) affects employer sponsored health plans and individually purchased (private) insurance. Some of the above posters are not accounting for that.
Third: HIPAA comes into play as well - and has been around much longer than PPACA. Again, big differences in how preexisting conditions are covered/denied when it comes to employer vs. individual plans.
Fourth: The state in which you reside also plays a factor, particularly with individual insurance. This also matters if the employer sponsored plan you just enrolled with is fully or self funded.
Bottom Line: there is no (and never has been) some massive, super-secret database out there where people are red-flagged or black listed because they were once diagnosed with something or other. What can happen, is you may be asked if you have ever been treated for X or Y by a new, prospective insurance company. Also, an insurance company may send a letter to current or former health care provider asking them if they have treated you for X or Y. And then it goes from there. The most important thing you can do to protect yourself is to familiarize yourself with your rights under COBRA, learn what Continuous Creditable Coverage means and how that works, and if you have either a conversion privilege or portability available to you if your current coverage terminates for whatever reason.
posted by thatguyjeff at 1:59 PM on January 31, 2011
Second: there's some big differences in how the latest health care reform law (PPACA) affects employer sponsored health plans and individually purchased (private) insurance. Some of the above posters are not accounting for that.
Third: HIPAA comes into play as well - and has been around much longer than PPACA. Again, big differences in how preexisting conditions are covered/denied when it comes to employer vs. individual plans.
Fourth: The state in which you reside also plays a factor, particularly with individual insurance. This also matters if the employer sponsored plan you just enrolled with is fully or self funded.
Bottom Line: there is no (and never has been) some massive, super-secret database out there where people are red-flagged or black listed because they were once diagnosed with something or other. What can happen, is you may be asked if you have ever been treated for X or Y by a new, prospective insurance company. Also, an insurance company may send a letter to current or former health care provider asking them if they have treated you for X or Y. And then it goes from there. The most important thing you can do to protect yourself is to familiarize yourself with your rights under COBRA, learn what Continuous Creditable Coverage means and how that works, and if you have either a conversion privilege or portability available to you if your current coverage terminates for whatever reason.
posted by thatguyjeff at 1:59 PM on January 31, 2011
If you have access to an FSA account, use that instead, and find someone with a sliding scale. They'll be HAPPY to discount for someone paying cash and you'll keep it off your record, which will help you when you need health, life, or disability insurance in the future.
You might have options on your meds, too. It's worth finding a therapist who takes these concerns seriously and asking them what their recommendations are.
If the FSA idea isn't an option, just go for it with your insurance. Yes, it might (or might not) be a nuisance later but not by a long shot as much as a nuisance as debilitating anxiety is now.
posted by small_ruminant at 2:20 PM on January 31, 2011
You might have options on your meds, too. It's worth finding a therapist who takes these concerns seriously and asking them what their recommendations are.
If the FSA idea isn't an option, just go for it with your insurance. Yes, it might (or might not) be a nuisance later but not by a long shot as much as a nuisance as debilitating anxiety is now.
posted by small_ruminant at 2:20 PM on January 31, 2011
Response by poster: I highly doubt I could maintain continuous coverage when this insurance ends. I live close to the edge money-wise, and I would be unwilling to choose Cobra health insurance over food. This coverage is a temporary thing, probably lasting 2 years or so before a big chunk of time where I will likely have no coverage. That probably changes things, and makes me feel like my original concerns were pretty reasonable. If I had the money, I would do it all off-book with sliding scale. Maybe I will just risk it, and get treatment, and assume I wont have insurance again for the foreseeable future anyway--but it feels so reckless given this infuriatingly exploitative system. Thanks for the answers though.
posted by asimplemouse at 2:39 PM on January 31, 2011
posted by asimplemouse at 2:39 PM on January 31, 2011
//They didn't have an option to jack the premium based on health conditions, because they never asked about them.//
It's already built in to the price. If the insurance company can not discriminate based on medical history, then they do a lot of math and statistics to determine what to charge so that they are making enough excess profit on the healthy folks to cover the fact that they are going to lose their asses on the not-so-healthy folks. Given a large enough universe of members, it becomes a fairly straight forward exercise in statistics to estimate how many diabetics, or people with high cholesterol or blood pressure are in the member population, and how to charge everybody accordingly.
Obama cannot wave a magic wand and make the costs of chronic diseases go away. Either everybody pays their own way, in which case people die from lack of access to affordable health care, or we agree as a society to share the costs of the chronically ill. In the US, we seem to be in favor of the latter option, as long as the system is constructed to appear as though "somebody else" is picking up the tab.
posted by COD at 3:15 PM on January 31, 2011
It's already built in to the price. If the insurance company can not discriminate based on medical history, then they do a lot of math and statistics to determine what to charge so that they are making enough excess profit on the healthy folks to cover the fact that they are going to lose their asses on the not-so-healthy folks. Given a large enough universe of members, it becomes a fairly straight forward exercise in statistics to estimate how many diabetics, or people with high cholesterol or blood pressure are in the member population, and how to charge everybody accordingly.
Obama cannot wave a magic wand and make the costs of chronic diseases go away. Either everybody pays their own way, in which case people die from lack of access to affordable health care, or we agree as a society to share the costs of the chronically ill. In the US, we seem to be in favor of the latter option, as long as the system is constructed to appear as though "somebody else" is picking up the tab.
posted by COD at 3:15 PM on January 31, 2011
Here's some insight regarding depression diagnosis
Life insurance and yes, they will access your med records if you ask for a policy over $250k (to work around it, use 2 different insurance companies for $250k each)
Denied for additional coverage after listing depression
So is there a secret database flagging people? No because it's not a secret. Major illness of any kind and increasing the risk pool for long term cost coverage (meaning schizophrenia or even conflict of a diagnosis) can equate denials if you apply for individual coverage.
Again, safest bet is the most generalized diagnosis possible.
posted by stormpooper at 6:23 AM on February 1, 2011
Life insurance and yes, they will access your med records if you ask for a policy over $250k (to work around it, use 2 different insurance companies for $250k each)
Denied for additional coverage after listing depression
So is there a secret database flagging people? No because it's not a secret. Major illness of any kind and increasing the risk pool for long term cost coverage (meaning schizophrenia or even conflict of a diagnosis) can equate denials if you apply for individual coverage.
Again, safest bet is the most generalized diagnosis possible.
posted by stormpooper at 6:23 AM on February 1, 2011
This thread is closed to new comments.
I say go for it.
posted by KathrynT at 11:23 AM on January 31, 2011 [2 favorites]