Biopsy Now?
February 26, 2013 3:18 PM   Subscribe

The situation: My work-related insurance coverage for my daughter ends May 1. She has found a lump, which the docs want to watch for 6 months and then decide about a biopsy. She is 22 and our first thought, before this news, was to allow her to be uninsured through the Summer.

She called, only to give us a heads-up about billing/insurance with this. She was having an annual and a lump was found in her breast. She said that she's had it for awhile and it has not changed. Statistically, for her age, the probability is that it is not cancer. No family history, good diet, etc. She did have an ultrasound on it, which resulted in the advice to wait 6 months and re-check.

But we are freaking out because, one, my child, cancer, etc. But also, insuring her past the cutoff of my work insurance ending is very very expensive.

She is a student, and we can get her student insurance, which we have waived up to now. My only concern is that this lump may be judged to be a pre-existing condition, since she has been seen about it.

It is hard for me to be rational about this, and she is my adult offspring, not my child, although we are still paying for a lot of her life. We could:

1. Advise her to get a biopsy now. If it is malignant, then of course we continue covering her. If not, well, we feel more sanguine about letting it slide, or signing her up for student insurance.

2. Bite the bullet and start forking out $506 per month, at least through the 6 month watching period.

3. Get student insurance (she lives and attends college in another city), around $500 per term, and pray that they do not deem this a pre-existing condition.

#1 seems the best choice, although a biopsy is painful, invasive, traumatic, etc.

Given all the above info, what would you do, as a parent?
posted by Danf to Health & Fitness (21 answers total) 1 user marked this as a favorite
She should call her doctor immediately and explain the situation. Tailoring care around insurance eligibility is more common than you'd think (ugh). That said, surely if her doctors thought it had a strong chance of being cancer, they wouldn't have asked her to wait 6 months in the first place? Don't borrow trouble.
posted by ThePinkSuperhero at 3:25 PM on February 26, 2013 [3 favorites]

Obamacare allows children up to 26 to remain on their parents' insurance. I'm not clear on the details, but I'm guessing that's only if the parents picks up the tab? Is that where you are getting the $506 from?
posted by entropicamericana at 3:29 PM on February 26, 2013 [1 favorite]

A biopsy is not painful or traumatic and is only minimally invasive since at the very early ruling out stage your daughter is almost certainly having a needle biopsy and not a surgical biopsy. Even surgical biposy is done under a local as an out-patient. By all means, go for #1. You will all rest a lot easier.
posted by DarlingBri at 3:29 PM on February 26, 2013 [6 favorites]

Pre-existing conditions only matter if you don't have continuous coverage. If she goes from your work insurance to student insurance then she will have continuous coverage and everything should be covered. Here is one page that explains some of the concepts.
posted by ChrisHartley at 3:31 PM on February 26, 2013 [5 favorites]

Are you absolutely positive that your employer-based coverage will end for your daughter in May? One of the earliest pieces of the Affordable Care Act (healthcare reform) to go into effect in 2010 was to require employer-based health plans to extend dependent-care coverage to children of their workers up to age 26:
Plans and issuers that offer dependent coverage must offer coverage to enrollees' adult children until age 26, even if the young adult no longer lives with his or her parents, is not a dependent on a parent's tax return, or is no longer a student... Any qualified young adult must be offered all of the benefit packages available to similarly situated individuals who did not lose coverage because of cessation of dependent status. The qualified individual cannot be required to pay more for coverage than those similarly situated individuals.
So, unless there is something very special about your plan that allowed it to be grandfathered in (unlikely in my understanding), they can't end coverage for your daughter just because she's no longer a full-time student in May. You might want to give the Department of Labor a call and get more information if your employer insists that this isn't the case--that would be the first avenue I'd pursue.
posted by iminurmefi at 3:42 PM on February 26, 2013

I am retiring on May 1. This has been in the works for over a year, all the paper work is signed, and the state retirement system is fired up and running. I do not see a way to "undo" this.

Part of the deal for retirees on my organization is that they can hold on to their coverage, but dependent coverage is significantly higher. For an example, the cited $506 for Daughter, and it would be around $1100 monthly for Wife and Daughter.

For me alone, it is $96 per month to continue up to age 65 (I am 62 now).
posted by Danf at 3:47 PM on February 26, 2013

There are plenty of other health issues that could crop up for her over the summer that are a lot more expensive than the insurance cost. I'd continue coverage if at all possible.
posted by TheAdamist at 4:06 PM on February 26, 2013 [2 favorites]

If you sign up for student insurance to start when your coverage of her ends, then there is no issue with pre-existing conditions. The pre-existing condition exclusion is to prevent you from only getting insurance when you are sick; if you have always had insurance, there's no free ride so nothing to legitimately stop. (they only apply if you are uninsured longer than a certain amount of time, AFAIK; confirm with an insurance broker).

Also consider getting her high-deductible insurance. For example, which is probably <$150/mo. May or may not be a better deal than the student insurance.
posted by flimflam at 4:15 PM on February 26, 2013 [2 favorites]

Agree with the above that preexisting conditions are only an issue if there is no continuous coverage, so the student insurance may cover that. However, that insurance may not be nearly as comprehensive as the coverage you currently have. Also agree that biopsies are not that traumatic, and the peace of mind will be worth a lot. Get the biopsy.

Also, it is entirely likely that you could, if you wanted, reverse the retirement process. I deal with state retirement systems fairly frequently, and it is not unusual for people to change their minds. Whether this applies to you, and whether it's something you want to consider, is a totally different matter, of course, but it might be an option if the $1100/month is a deal breaker.
posted by dpx.mfx at 4:19 PM on February 26, 2013

#1 seems the best choice, although a biopsy is painful, invasive, traumatic, etc.

Just to ease your fears a little on this score (if it's the route you decide to go): I've had several breast biopsies, and they weren't terrible; a little twilight anesthesia (though the last time they just gave me a local, at my request), a couple of stitches, and an Rx for a few day's worth of Vicodin. No trauma at all.

Bonus: the first time I had the twilight, it made me feel so good that I asked the anesthesiologist out on a date while I was coming out of it.
posted by scody at 4:20 PM on February 26, 2013 [3 favorites]

This recent information may be of interest to you regarding a rise in breast cancer among young women.

From the article and regarding the idea of waiting 6 months and then rechecking:

When a younger woman does seek medical help for worrisome breast symptoms, she should expect the doctor to take the symptoms seriously and not suggest a prolonged period of watching and waiting.

Given your circumstances I would at the very least suggest that your daughter get a 2nd opinion to see if a biopsy is warranted now.
posted by Seymour Zamboni at 4:44 PM on February 26, 2013

If, god forbid, it is cancer, everyone will regret not having done the biopsy and started treatment earlier. Of course the likelihood is that it isn't, but wouldn't it better to know now and not spend 6 months worrying? I would get the biopsy and then go from there.

I'd never recommend that anyone go uninsured, just because even if you ARE healthy, what if you get hit by a bus? It would ruin you financially.
posted by Countess Sandwich at 5:02 PM on February 26, 2013 [1 favorite]

Needle biopsies are neither invasive nor traumatic. She should just get it done ASAP.
posted by fingersandtoes at 6:27 PM on February 26, 2013

Sounds to me like the biopsy is unnecessary and that it is highly unlikely to be malignant given her age. That said, I think it's a bad idea to go without insurance if at all possible, for any period of time. Help her find the lowest-cost option to tide her over between the end of your plan and the beginning of her next job.

Good luck to all of you.
posted by Philemon at 7:45 PM on February 26, 2013

Have her call the doctor and explain the insurance situation. The doctor will have heard this problem before and will move the biopsy forward.

Regarding insurance. You need for her to have it, because you have ended your earning years and need to be conservative with your funds. Lets say she has a minor accident - falls and hurts her knee. That's x-rays, MRIs, PT. And there is no way you're letting your child suffer without proper care. That would mean dipping into your principal.
posted by 26.2 at 8:10 PM on February 26, 2013 [1 favorite]

Check with the school about when she's eligable to go on the student insurance. I know that for my school, if you don't sign up at the beginning of the school year, you're not eligible unless there's some sort of qualifying event. Your retirement would qualify, since that's where she's getting her coverage now, but she wouldn't be able to switch to the student insurance until May 1.

The other thing to keep in mind is that if the lump turns out to be something, the student insurance might only cover non-emergency care in the city where she goes to school, not the city where you live. This is definitely the case with my insurance, for example.
posted by matildatakesovertheworld at 8:53 PM on February 26, 2013

Nthing getting it pronto....and my understanding of Obamacare is that health insurance can no longer be denied because of pre-existing conditions.
posted by brujita at 12:02 AM on February 27, 2013

my understanding of Obamacare is that health insurance can no longer be denied because of pre-existing conditions.

Yes, but the prohibition of pre-existing condition exclusions doesn't take effect till Jan. 1, 2014. (There are certain exceptions that took place in 2010, but it won't be universal till next year.)
posted by scody at 12:11 AM on February 27, 2013

Get the biopsy now. If it's nothing, go back to your original plan of student insurance. If it's malignant, the $500 a month will be spit in the bucket of billing headed your way and that insurance will be the best money you ever spent.
posted by DarlingBri at 5:09 AM on February 27, 2013 [1 favorite]

Incredibly squeamish and pain-averse woman here. I have had 2 needle breast biopsies and it was nothing. Truly -- nothing. It took a couple of days for the cytology to come back confirming there were no malignant cells. The biopsy procedures took 2 minutes and I was completely numb. This is probably a fluid-filled cyst, and it's probably nothing, but the problem is you and your daughter don't know that. If it isn't, it could be something you and she can't afford to miss.

If you allow her insurance to lapse, and it turns out to be something serious, it may not be covered under her new insurance. I'd advise the biopsy now, while she is covered. If it is something that needs intervention - she's covered. If not, you can then make a more informed decision about eliminating any insurance gap.

Also, something to keep in mind is that it may not be just the procedure cost that isn't covered. Lab fees for pathology or cytology will also be assessed.
posted by citygirl at 7:39 AM on February 27, 2013

Thank you citygirl, and all. . .

At this point all of the costs of a biopsy and lab would be out-of-pocket, as we are no where near the deductible ceiling.

This is HER decision, but she would also do well to listen to all of the options and ramifications. We'll talk to her very soon.
posted by Danf at 7:56 AM on February 27, 2013

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