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HelpMeOmg's avatar

Help I have a number of "pending" medical issues (United States)

Asked by HelpMeOmg (79 points ) July 8th, 2012

I have just got a new job with a good health insurance policy. I do not plan on making this job my career and plan on leaving within a year. I have a number of medical issues such as chronic neck\back pain that I intend to get “fixed” while I have insurance. I’m worried that if I go to a doctor and actually use my insurance I will be flagged for life as having preexisting conditions and will screw myself in the long run because next time I go to get coverage (either on my own if I work for a small company or otherwise) I will either be denied or forced to pay crazy $500/month premiums. Am I better off paying cash to keep these things off the books?

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23 Answers

Fly's avatar

I would not worry about it- go ahead and take advantage of the insurance while you have it. Under the Affordable Care Act, you can buy into the federally funded Pre-Existing Condition Insurance Plan if you have a pre-existing condition and can’t get insurance. And after 2014, insurance companies will not be able to deny care or charge insane rates for adults with pre-existing conditions.

HelpMeOmg's avatar

The high risk pool costs a lot of money though. They are not an option because they are cost prohibitive. I much rather spend a thousand now to save $500 /month later. I’ve always been scared of letting insurance companies know things for this reason. All my fender benders were settled with cash and that’s why I pay very cheap for insurance. Who knows if Obamacare is going to be around or if it changes or whose going to win this election.

Would something like getting back pain fixed at the chiropractor screw me for life so to speak? If I pay cash no one will ever know but it’s a lot of money and I’m not sure if it’s financially worth it considering I have insurance. Are the results of lab tests\physicals reported? Obviously the insurance company will find out if I start taking prescriptions but these can always be bough online with cash from a reputable offshore pharmacy.

Am I worrying too much or should I just use the insurance?

EDIT: How long do preexisting conditions stay on your “record”

Blueroses's avatar

Get it taken care of while you have the insurance. If/when you leave your job before 2014, take advantage of OBRA to keep your current insurance. You don’t have to live in pain and maybe it’s not as serious a problem as you have built it up to be in your mind.

I despise our current insurance climate for just this reason. Get it over with! Get the help you need! Why else are you paying the premiums? The only thing they’re insuring right now is that you’ll be too afraid of increases to actually get treatment when you need it.

JLeslie's avatar

I am not a doctor.

Doctors can rarely do anything for head and neck pain. If it is muscular you can be given exercises to strengthen the muscles and you can take drugs like Advil or Alleve yourself in perscription doses. If it is a disc, still exercises and rest most likely. If it is God forbid a tumor or cancer, then you need to find that out. If the pain comes and goes probably not cancer. Xrays don’t cost that much, maybe you can just get a few xrays and verify it is nothing serious.

This very thing is one reason why our system is so horrific. People uninsured don’t go to the doctor, and people insured are even still afraid to go to the doctor.

I don’t know if back pain even qualifies as a pre-existing condition? Does anything and everything count? It isn’t like diabetes, heart disease, and cancer. I have no idea the answer.

Fly's avatar

@HelpMeOmg As I said, I would just use the insurance. My mom actually has insurance through the PCIP and her rates are not unreasonable at all. You can’t no for sure how much it will cost you until you apply.

I am not certain that back pain alone will necessarily be considered a pre-existing condition; have you ever been treated for it before?

And cutting corners for prescriptions to avoid having it on your insurance is unnecessary nonsensical- as opposed to the one-time costs you described above, you will be paying full price for your medications on a monthly basis and you will just be wasting your money while still paying your insurance bills.

I am not sure about whether or not tests and physicals are reported to insurance companies (I am 18 and still under my dad’s policies) but I would imagine so, especially if you are using insurance to pay for these tests. (And blood tests can be extremely costly to pay for out of pocket depending on the test, so insurance saves significant amounts of money in this area.) But it is also my understanding that you have to undergo a physical and possibly some blood tests before applying for most insurance plans, and that anything found during the physical/tests (i.e. chronic back pain) would go on your medical records and be reported to the insurance company regardless.

ETpro's avatar

Paying cash won’t keep it “off the books”. It’s part of your permanent medical record, and while that’s your personal information, insurers will not write healthcare policies unless you agree to disclose it. Don’t vote Republican. The Affordable Care act will make this whole silly mess go away if it isn’t repealed.

JLeslie's avatar

Actually, @Fly brings up a good point, it won’t matter if soething is diagnosed while using insurance or not, it is still pre-existing if it qualifies as pre-existing. My BIL had to wait to get diagnosed with rectal cancer until his insurance was approved. Long story, but if he had been diagnosed by paying out of pocket, it still would have been pre-existing.

HelpMeOmg's avatar

Well I know for a fact there is no such thing as a “permanent medical record”. Insurance companies only know what they paid for in the past, what you declare, and possibly what hospitals report (they check your MIB file). The random doctor that keeps paper medical records reports to no one. Insurance companies will never know you were there. Obviously some things like rectal cancer can be proven to have been there for years and would be pre-existing. I have coverage now and they can’t prove i’ve always had back pain. I’m worried about future insurers finding out. for my eye doctor I was able to get lower self pay rates by simply explaining that I’m uninsured (i was at the time) and asked for a break. He reduced by $50. But I guess like you all said if I’m paying for it I might as well use it.

It’s not just back pain btw, it’s other conditions as well that I may have to take medication for.

Blueroses's avatar

The fuck-all about “pre-existing” is that it’s the insurance companies who define the term.

My friend’s grandchild was diagnosed with a genetic-linked cancer at the age of 18 months and the parent’s insurance denies the claim as pre-existing because the mother didn’t get a (non-covered and optional) pre-natal test for it.

HelpMeOmg's avatar

@Blueroses That’s very sad. That is one of the great things about Obamacare. Some of the other points are not so great but this is one point I applaud him for. I think insurance companies should not be able to look into anything and assess risk that way. I do understand rates may be higher but human life is not a commodity. I understand the concept of risk and the notion of “pay your own way” but no one should be denied or effectively denied with high rates simply because of a condition especially if they had no control over it.

JLeslie's avatar

@HelpMeOmg Although I agree cancer is different than back pain, unless again, God forbid, the pain is from cancer; my BIL did not have rectal cacer for years. He had symptoms, got diagnosed when it was six centemeters already, and the doctor said in another month the cancer would be completely blocking his rectum. It was not pre-existing because it had not been diagnosed before. It has nothing to do with how long the cancer has been the. His seems to be a very aggressve cancer but even if it was prostate cancer, which generally is very slow growing and can be there for years, I don’t see the difference.

After reading all the answers and thinking about it more, I would use the insurance and get checked out since you have additional concerns besides back pain.

srmorgan's avatar

Just a comment or two.
In my experience, employer-sponsored group medical insurance usually does not carry a life-long restriction based on a pre-existing condition. A group policy might not cover pre-existing conditions for three or six or twelve months, some have no restrictions, but not for the rest of your lifetime.

There are databases of one’s medical history. Don’t make that mistake. The same dissemination of information concerning prescription drugs also goes on.

As a condition of any medical or even life insurance policy, you consent to permitting your medical information be distributed to various medical rating and history bureaus.

I sold life and long-term care insurance for a while and all of of our underwritten applications were checked for medical history to ensure that the applicant’s statements about medical history were honest. I had several applications declined because customers flat out lied about medical history.

HelpMeOmg's avatar

@srmorgan

I understand there are records but you can kind of tell what will most likely be found out. Remember your medical records are private and you must consent to a release. Insurance companies make you consent.

Let’s say you go to Dr. J, Dr. Y, and Dr B under an insurance policy. Your MIB file contains payouts to Dr J, Y, and B. Your next insurance policy will ask you to release your records. They will go into J, Y, and B’s record because they KNOW you were there. They can then legally pull them because you consented. I’m sure they also automatically check all major hospitals as well.

Let’s say you went to Dr. Q, an independent physician (not part of a large hospital chain or medical network) as a cash pay. Also assume that you didn’t pull any prescriptions under insurance written from Dr. Q. There are no laws requiring Dr. Q to release the fact that you were there to some public record, in fact that would be illegal under HIPPA. Even if HIPPA didn’t exist Dr. Q would have no reason to release the fact that you were there. If they don’t know you were there (and you don’t declare it) they won’t be able to pull your record from that place. There are so many doctors they could not possibly inquire (in a non standard way) as to if you were at this doctor or that doctor. I can see that being true for large hospitals but not small doctors. In short no one knows.

Blueroses's avatar

I do work in the pharmacy side of healthcare and can reaffirm what was said about it not making a difference if you pay cash or go through insurance for any prescription. It’s all linked.

If you were given a script for fluoxetine to fill at my pharmacy, I see instantly that you have filled sertraline 30 days ago at another pharmacy in another state even. It doesn’t matter if you used insurance.

This is ostensibly for your own good. We can tell if anything you might be taking could interact with a new prescription, but it’s largely based on our climate of fear of law suits. Right now, insurance companies are hiring pharmacists and technicians to look at those prescription records, regardless of claim history, to establish a pattern of pre-existing conditions. (In my example, the insurance company would see a pattern of depression/anxiety medications).

This has to end. Health Insurance and coverage has to stop being a for-profit “industry”.

HelpMeOmg's avatar

@Blueroses

How would you tell that (someone pulled a Prozac script from another pharmacy)? You don’t give a SSN or unique identifier to fill a script for a non DEA medication. How would you tell one John Smith out from the thousands of others. A name is not a unique identifier.

I’m not questioning weather your right or wrong, I’m just wondering how you actually find the person.

Blueroses's avatar

@HelpMeOmg Name and date of birth are required for all scripts. All. DOB is given with ID at any doctor visit and included on the script. It’s possible, but unlikely, that both match somebody else.

JLeslie's avatar

@Blueroses Wait, you can see all scripts I have filled, any pharmacy, whether on insurance or not any drug? Or, just triplicate drugs? I am very glad to know this, if that is the case. About once every five to ten years I might ask for 10 xanax, and if the doc can see I basically never fill a script for it I can prove I am not a xanax junky. It’s so annoying to ask, wind up looking like a person is begging for a benso. It is a horrible catch 22. If you seem like you want it bad, you’re screwed.

Blueroses's avatar

@JLeslie It is a bit big brother-ish. When you fill a script, it is linked to everything you’ve filled that is similar (again, for your own safety?) and that link can go back several years but my screen will show that you haven’t filled xanax for 3 years. Your “day’s supply” isn’t an issue with your new script. But yep. We can see your script history, as it relates to your new fill.

HelpMeOmg's avatar

@Blueroses

Interesting. Nothing would stop someone from giving an invalid DOB. It’s sad we live in a society that one would have to go through such crazy measures just to maintain some form of anonymity and protect yourself. It’s sad that one would have to forgo these measures put in place for your safety.

Thanks for the info. I’m not going to do this because I would be going through insurance anyway.

JLeslie's avatar

@Blueroses I’m glad about it.

Blueroses's avatar

@HelpMeOmg All legit practitioners require photo ID before writing any prescription. You could give a false DOB and false name or claim you lost your wallet and you might get treated with ibuprofen and a bandaid, but you aren’t walking out of there with a prescription for anything unless you provide ID.

We can blame our legal system for making it easy to bring suits. We can blame our insurance system for being greedy fuckwads. We can blame pharma for making effective drugs so good that people want them all the time. We can blame doctors for making easy pharm recommendations instead of really looking at causes.

Regardless, our system is set up to track everything.

lillycoyote's avatar

@HelpMeOmg You have a limited number of options. You can continue your employer’s group health plan through COBRA until you get coverage from another employer or for 18 months after you cease being employed at your current job if you don’t get another job with health coverage. After 18 months your COBRA benefits would end, but that will be expensive because you have to pay both your share, and your employers share of the premiums.

Did you even bother to check out the Pre-Existing Condition Insurance Plan provided through the Affordable Health Care Act that at @Fly cited? If you click on your state you will see the premium rates and they are not that high. Those are your options.

That is one of the most important provisions of the Affordable Health Care Act and it is already in effect. No one can, now, be turned down for insurance due to a pre-existing condition. Your state will either have already had or opted to create a high risk pool or your state has opted into the federally funded program.

bkcunningham's avatar

@HelpMeOmg, what type of procedure to you think it will take to fix your chronic neck/back pain and how much do you think that procedure would cost if you paid it out of pocket?

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