insurance reassurance
June 21, 2012 4:47 PM   Subscribe

Where does one go for reliable information about any risks of using your health insurance policy?

I have questions about the potential fall-out of getting health care under health insurance. My son is the beneficiary, and this is mental health care for anxiety. His mom is concerned, based on some analogous experiences that she's heard about, that our continuing his care over a long term may cause him problems getting health and/or life insurance. (We also disagree about whether further care is warranted, but this question is about the insurance side, tempting as it is to talk about all sides at once.) Can mefi can point me to objective, informed people to ask for the best possible information about it. Are there insurance consultants or government offices that can give solid information about this, preferably the kind you can go back to when the insurance company tries to balk and say "here it is in writing, the regulation or piece of our contract that says you have no right to balk"

The closest things I have are the doctor and the insurance company. The doctor might be biased and I think usually isn't the best-informed about insurance issues. The health insurance company has totally whacked out biases, and I've found when issues have come up that the customer service reps I've spoken to have sometimes been quite wrong. It might just mean that the fallout is so unpredictable that nobody can know and I should just put my head in the sand and discontinue the care. sigh.
posted by anonymous to Law & Government (14 answers total) 5 users marked this as a favorite
I'm assuming US here (any questions about confusing / complicated insurance are likely US...)

One factor will be the ruling on the Affordable Care Act, expected soon (potentially next week). Currently that law prohibits insurers from discriminating against or charging higher rates for pre-existing medical conditions, starting in 2014. So not quite yet, but if that law stays then relatively soon pre-existing conditions should not be much of an issue.

But the Supreme Court is ruling on it soon and it is quite possible this provision will be thrown out, in which case we're back to the current/old status where pre-existing conditions can increase rates or deny coverage. On group plans (like through an employer) this is usually less of an issue, mostly there will be some sort of delay period (pre-existing conditions not covered for X amount of time or something), but that varies. Individual insurance can definitely be harder to get.

There are a LOT of factors in the current regime, varies based on state / insurance company / type of policy / etc.
posted by wildcrdj at 5:00 PM on June 21, 2012

I think the health insurance and the life insurance concerns are separate issues. The health insurance part of it is a pre-existing condition issue, meaning that if you lose health insurance for more than 63 days (I think that's right) and then get new insurance, there might be a further delay before treatment related to this pre-existing condition is covered. As wildcrdj suggested, the new health care law is supposed to change that.

Life insurance underwriters may have questions about it, because they don't want to insure someone who might kill themselves, but it's not at all an automatic dealbreaker.
posted by jon1270 at 5:05 PM on June 21, 2012

If your state has an insurance ombudsman (such as), you can call that office and get answers. My experience was that they were super-nice, understood that health insurance can be super-stressful for consumers and were very reassuring and calming and cool with answering the same question 400 times, and very knowledgeable. Honestly one of the best experiences I've had with state government and the woman I talked to on the phone was SO sympathetic and never talked down to me, while explaining things very clearly.
posted by Eyebrows McGee at 5:30 PM on June 21, 2012

Don't discontinue the care if he needs it and is getting better. If you're concerned about the health insurance issue and don't find the answers you need, figure out a way to pay cash. But if your son is a minor, and needs care, and can't pay for it himself, it's in his best long-term interests for you to figure out a way to get him the care he needs. If you don't find what you're looking for with this question, that should be your next question.
posted by bleep at 5:30 PM on June 21, 2012 [1 favorite]

I don't think the Affordable Care Act prohibits insurance companies from charging higher rates for pre-existing conditions. It prohibits them from refusing coverage due to pre-existing conditions. My wife is a Type I diabetic. Our rates will not be miraculously dropping in 2014.
posted by COD at 5:43 PM on June 21, 2012

I don't think the Affordable Care Act prohibits insurance companies from charging higher rates for pre-existing conditions. It prohibits them from refusing coverage due to pre-existing conditions. My wife is a Type I diabetic. Our rates will not be miraculously dropping in 2014.

I don't know if it's different for existing plans, but the ACA website suggests that it does in fact prevent insurance companies from charging higher rates for pre-existing conditions:

Prior to the enactment of the Affordable Care Act, your insurance company can decide what is a pre-existing condition and refuse to sell you a policy, charge you two or three times more, or limit your benefits so that your condition is excluded.
Thanks to the Affordable Care Act, we have already prohibited these practices for children and by 2014 that will be the law of the land for all Americans.

See if your state has a hotline for you to call in for more information.
posted by roomwithaview at 6:05 PM on June 21, 2012 [1 favorite]

COD is wrong. The Affordable Care Act institutes Community Rating regulations, "which require health insurance providers to offer health insurance policies within a given territory at the same price to all persons... regardless of their health status.

Of course, the US Supreme Court (or, more accurately, five Justices) may overturn this law. So wait a few more days until you rely on it.
posted by alms at 6:16 PM on June 21, 2012 [1 favorite]

Every time someone asks this question, I think the answer is always "It will ruin his ability to get health insurance privately for the rest of his life. Hope he can always be employed by a big employer." Followed up by "but if he needs the care..." and "hell, you can get denied by private insurance for having a cold once."

I'd recommend keeping it off the insurance books if you can until 2014, if that law passes. But that's not always possible.
posted by jenfullmoon at 7:46 PM on June 21, 2012

Most states have risk pools for people denied health insurance for preexisting conditions (although the premiums are typically high). The government office that can best answer your questions is that of your state insurance commissioner.
posted by Wordwoman at 9:22 PM on June 21, 2012

Life insurance should be fine -- depending on the state -- though there is sometimes a period during which a policy can be contested (usually 2 years) and during the contestable period, a claim could be denied. After the contestable period, maintain the policy going forward and the policy becomes "incontestable".

You can me-mail me if you want an answer more specific to your state/situation.
posted by countrymod at 6:17 AM on June 22, 2012

If you have a preexisting condition, the only reason to not get it paid for by insurance is if you intend to lie about/hide it in the future. In which case you'd best pay cash and use an assumed name. It's not the same as not making a claim on your car insurance.

I don't think *anyone* can give you reliable information about what is likely to happen in the future with health insurance. Make your decision based on what is best in the here and now.

Also, this differs state to state. If you're in Massachusetts, you have a lot less to worry about than if you're in Texas.
posted by mskyle at 6:22 AM on June 22, 2012

It might just mean that the fallout is so unpredictable that nobody can know and I should just put my head in the sand and discontinue the care.

If you end up having to put your head in the sand, you might as well continue getting your son the care he needs. After all, that is what insurance is supposed to be for. Right now the insurance system in the US is pretty broken, as you're finding out. It may stay broken or it may get fixed in the future. But you shouldn't let that stop you from helping your son today.
posted by alms at 7:32 AM on June 22, 2012

[This is a followup from the asker.]
Thanks all. I'm in Maryland.

Today I tried calling this office but it was not at all useful for this purpose (They said they work on non-payment and billing questions, as well as helping the uninsured.) They pointed me to my doctor and to the insurance company, and also let me know that there is no insurance ombudsperson for MD except for Medicare and caid.

I do know someone who's had life insurance denied for mental health diagnoses, though they were more serious than what I'm dealing with presently.
posted by cortex (staff) at 11:01 AM on June 22, 2012

« Older Masterlock? Maybe just journeymanlock.   |   Antivirus protection without the Internet Newer »
This thread is closed to new comments.