Being ill & undiagnosed. Ramifications on health care coverage as preexisting condition?
February 16, 2011 3:07 PM   Subscribe

I'm ill but will be leaving my job (with medical insurance) for another one (with different medical insurance coverage). Should I hold off on getting a medical diagnosis since it's not life threatening just chronic?

I've been generally unwell for the past year or so with "flares" of symptoms that include profound fatigue, joint aches, swollen limbs, night chills coupled with an immune system that can't fight a cold. I've had an active cold the last 3 months. All symptoms point to some auto-immune disorder. I was sick a lot as a child where I missed weeks of school at a time and the symptoms I'm experiencing are the same.

While I've been fortunate to have enough sick leave from work, I feel like I need to take extensive leave (FMLA) in order to rest and recover. The problem is that I'm relocating to another state and will be looking for a new job within the next 3 months. If I push for a medical diagnosis and get a doctor to sign off on my FMLA, will I be screwing my self with getting diagnosed with a condition that my next employer's insurance will preclude as a preexisting condition?

I'm not asking for a medical opinion on my symptoms but maybe getting feedback from people who've had experience with having a chronic disease and how insurance coverage worked for them. Is the best situation for me to get on my domestic partner's insurance? It will likely be the same plan I'll be on at my next job.

Your responses would be helpful in planning my next move. I wish good health to all of you. Thanks for reading.
posted by loquat to Health & Fitness (12 answers total) 2 users marked this as a favorite
if you've been sick for three months and aren't getting better, don't put off getting medical attention for three more months because of insurance issues.
posted by thinkingwoman at 3:10 PM on February 16, 2011 [1 favorite]

If you will be on the same plan, then you should be able to find out if the insurance company actually has a policy about pre-existing conditions. In my personal experience, my company's group plan did not deny coverage for such.
posted by Brocktoon at 3:35 PM on February 16, 2011

If you can get on your partner's plan now, that would probably be best, that way you will have no worries about whatever treatment may entail while you're between jobs. It will be easy to switch to your own plan once your new job starts.
posted by amethysts at 3:39 PM on February 16, 2011

if you can hold off, do hold off. which is not the same putting off treatment.

i was diagnosed with lupus and my doctors specifically danced around it a little for a while for insurance reasons. (IANAD but your symptoms are familiar.) my dr still treated me, etc - but was very conservative about the official diagnosis. autoimmune and other diseases can be hard to pin down specifically and three months isn't a particularly long time to be sussing things out (i went undiagnosed for 17 years - then a couple months once the right doctor finally put the pieces together). at some point you'll need a diagnosis, but you might not necessarily need it for initial treatment.

getting on partner's insurance isn't a bad idea - is there a reason you wouldn't just do that? it seems like it would solve present and future insurance issues.

also, talk to your doctor. most have experience with the insurance crap.
posted by crankyrogalsky at 3:48 PM on February 16, 2011 [1 favorite]

Is the best situation for me to get on my domestic partner's insurance?

I'm dealing with similar questions. Due to budget cutbacks, my employer got rid of my old health benefits and replaced them with something else at the start of 2011.

So I am having to decide whether to go with my partner's insurance plan, or stick with the new plan that my employer has put me on, while dealing with the expenses around a chronic health issue that popped up last year.

One issue that is keeping me on my current plan is the deductible, which due to care I have received in January is a limit that I have already reached. At this point, I just have the percentage co-pay to cover.

If I switch to my partner's plan, I am essentially resetting the deductible "clock" — and because we would then be on the equivalent of a "family" plan, our deductible as a couple would be much, much higher than my current deductible.

I work for a non-profit, so expenses are something I have to watch. If your condition requires expensive medication, exams, etc. the cost of which might be issues for you, my advice is to review both plans, comparing the deductibles, in-network and out-network coverages, and other details to decide which plan makes more financial sense.
posted by Blazecock Pileon at 3:52 PM on February 16, 2011

You mentioned that you'll be "looking" for a new job in the new state. What guarantee do you have that you'll find another job (with benefits) in a reasonable amount of time post-move? If you don't take the time to rest and recover now will you be fit to work if you find a new job quickly?

All things being equal, and assuming your partner isn't changing jobs, you may want to get on their insurance now (which is another question - you often need to have a qualifying "life event" to enroll out of open enrollment.) This way you can take the time you need to rest NOW and be happy, healthy, and ready to find a new job post move.

Good luck!
posted by m@f at 3:53 PM on February 16, 2011 [1 favorite]

It does sound like it would be easiest to get onto your partner's plan if you can, if that will be consistent for awhile. So far every health insurance plan I have been on through work has not excluded pre-existing conditions -- I had thought that those were primarily for individual insurance policies rather than group, but I could be way off base -- but I think it's wise to be cautious with insurance companies. If you have a good relationship with your current employer, maybe you can discuss the insurance details with their benefits coordinator, who might understand the plan a bit better?
posted by countess duckula at 3:53 PM on February 16, 2011

Best answer: How long have you been working at your current position? I'm going to assume because you mention FMLA that it's been at least 12 months (or will be by the time you leave your job.)

If you've had health insurance coverage for a year, and you don't go more than 63 days without coverage, they cannot, by law, exclude treatment for your pre-existing conditions. However, you do need to keep the break between insurances less than 63 days, which you could do by enrolling in your partners' insurance or by maintaining coverage through COBRA.

Please do not delay testing and treatment for this illness. I have an autoimmune disorder, and cheap treatment with an antimalarial completely changed my life. No joke. $40 a month, saw a doctor twice a year, and my quality of life was so much better.

Here's the more technical text from HIPAA:
Title I also limits restrictions that a group health plan can place on benefits for preexisting conditions. Group health plans may refuse to provide benefits relating to preexisting conditions for a period of 12 months after enrollment in the plan or 18 months in the case of late enrollment.[1] However, individuals may reduce this exclusion period if they had group health plan coverage or health insurance prior to enrolling in the plan. Title I allows individuals to reduce the exclusion period by the amount of time that they had "creditable coverage" prior to enrolling in the plan and after any "significant breaks" in coverage.[2] "Creditable coverage" is defined quite broadly and includes nearly all group and individual health plans, Medicare, and Medicaid.[3] A "significant break" in coverage is defined as any 63 day period without any creditable coverage.[4]
posted by the young rope-rider at 5:18 PM on February 16, 2011 [2 favorites]

From a MeFite who would prefer to remain anonymous:
When I was waiting for insurance coverage to kick in and dealing with a chronic issue, I got some temporary symptom relief by going to a small family practice and paying cash (at a discounted cash rate). I checked through their paperwork and never signed anything that gave them permission to share my records with anyone besides me. I did not go back once I had health insurance, so they never communicated with my health insurance company about me. It's *not* a surefire way to avoid letting insurance companies know about pre-existing conditions, but if you're in great discomfort, it's something you can try.
posted by jessamyn at 5:37 PM on February 16, 2011 [1 favorite]

If you've had health insurance coverage for a year, and you don't go more than 63 days without coverage, they cannot, by law, exclude treatment for your pre-existing conditions. However, you do need to keep the break between insurances less than 63 days, which you could do by enrolling in your partners' insurance or by maintaining coverage through COBRA.

This. the young rope-rider is spot on.

IWIHIBANYHIG (I work in health insurance, but am not your health insurance guru)
posted by spinturtle at 5:45 PM on February 16, 2011

How do you know for sure that you will have a job? If it's not a certain/lined up already thing, I wouldn't risk it. For all we know, you could be out of work for a long time, and we don't know what insurance you're going to end up with (if any).

I'd definitely go with your DP's insurance and/or stall on a diagnosis.
posted by jenfullmoon at 6:50 PM on February 16, 2011

You can absolutely get FMLA without a definitive diagnosis. Speak honestly with your physician about your insurance conundrum. The doctor who wrote up my FMLA paperwork did not name a condition, but rather a variety of symptoms that precluded me from a normal work schedule. The word "chronic" is golden in getting approval.

When applying for FMLA, you might have a company specific form to fill out. These forms are made by legal teams and are designed to avoid approval through poorly staged questions. However, by law your company MUST also accept the standard Department of Labor FMLA form. That DOL form is fair and comprehensive.

Don't make anything harder on yourself if you can help it. Seek treatment but delay formal diagnosis. Until you are in a stable insurance situation, don't tell them anything they don't have to know. FOR REAL.

Good luck, I completely empathize.
posted by Bunsen Betty at 7:54 PM on February 16, 2011

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