<p>We need to apply for an individual policy for my 19yo and the question is whether the person has had symptoms or been treated in the past 5 years for a condition. The answer is no… but the pediatrician still checked it on last year’s physical as a diagnosis. To be blunt, the pediatrician claims he heard a wheeze on kid when kid was little (10 years ago) and diagnosed asthma and prescribed an inhaler. Doctor insisted I fill the prescription and I did for probably a couple of years. (I don’t think within the past 5 years.) Kiddo has never had an asthma attack and never needed the inhaler. I think the issue here is that an older sibling has very bad asthma and the pediatrician was quick to diagnose-- but now it’s on the paperwork. There have been no visits, meds or treatment within the past 5 years for asthma but, at the regular annual physical, the doctor checked ‘asthma’ as a diagnosis. What should we do?</p>
<p>I would explain your son’s situation to the doctor, and ask him to kindly correct his records so that asthma does not show up as a medical diagnosis. It can be so frustrating when the records are incorrect. Good luck. I can’t imagine that this should be hard to have changed.</p>
<p>I agree with above post. It’s important to correct ASAP so it doesn’t get put into electronic medical record, which IS said to be VERY hard to change.</p>
<p>In a related issue, regarding asthma, there is a well-respected school of thought that once an individual has asthma (other than in connection with an infection) you have asthma for life. It’s “twitchy” airways, like allergies are a lifetime issue. It can change over time–worsen or improve, especially pre & post puberty, but rarely disappears for good.</p>
<p>Even if your S had asthma checked on his form, it doesn’t sound like he was TREATED for it or had any symptoms in the past 5 years under their terms. Does NOT sound like a pre-existing condition, but I don’t work in insurance.</p>
<p>My guess would be it’s on the electronic record, but what do I know? Kiddo has been on the state health plan and the doc checks off asthma every year on the physical. Last year, I pointed out to the doc that kiddo’s never had an asthma attack and doc is checking it off. Doc went back into the record and told me, “Yup, we heard kiddo wheezing during an upper respiratory infection.” Like I said, that was a good 10 years ago. So the doc thinks it’s accurate but, no, kiddo hasn’t been treated or needed treatment in the past 5 years for it. </p>
<p>I even thought of taking kiddo to a new doctor to counteract the diagnosis-- but I imagine you can’t counteract asthma since it can come and go, right?</p>
<p>^^ Even if you could get another doctor to counteract the diagnosis, it won’t matter. Under our present system, once a condition has been diagnosed, that’s the end of it as far as the insurance company is concerned. It doesn’t matter if the diagnosis was incorrect (unless you’re up for a lawsuit, and juries are usually kind to plaintiffs against insurance companies). As we found out, it doesn’t matter if the condition has been successfully treated. Insurance companies don’t want anything to do with people who have even a whiff of illness.</p>
<p>But there is good news. On January 1, 2014, insurance companies will no longer be able to discriminate against people with pre-existing conditions, thanks to the Affordable Care Act. So if you can cobble something together for the next 16 months, you’ll have better options down the road.</p>
<p>In the meantime, if he’s been uninsured for at least 6 months, the new healthcare law has established a [Pre-Existing</a> Condition Insurance Plan (PCIP)](<a href=“About the ACA | HHS.gov”>About the ACA | HHS.gov). Click the link at the bottom of that page for a map to see what your state is providing.</p>
<p>Also, under the new law, if you or your spouse have coverage, he’ll probably be able to stay on your policy until age 26. Is that a possibility?</p>
<p>Yes, I’m well aware of the changes starting 2014. Unfortunately, what I didn’t know-- because it wasn’t nearly as well advertised-- is that had I applied for insurance for my kid <em>before</em> the 19th birthday, there would be pre-existing condition coverage. My concern is before 2014; by then, kiddo will be in a group plan. And no, I have no coverage. I have worked 10 years as a permalancer is a difficult industry and have had no benefits, including health insurance, during that time. The state plan for children was our saving grace.</p>
<p>Then you may need to get him a bare-bones policy until he gets that group insurance. Has he actually applied for insurance and been turned down? Or are you just anticipating at this point? It’s very possible he can get coverage, but with a higher premium than someone without a pre-existing condition.</p>
<p>ETA – When did he turn 19?</p>
<p>I applied and am waiting to hear back. Kiddo does have a pre-existing condition that I told them about (which could be excluded-- that doesn’t matter) and had some tests run that were all negative (so I don’t know how that will play out) but I didn’t include the asthma information and now I am wondering whether to call and tell the insurance company. Kiddo doesn’t have it but I don’t want there ever to be an accusation of fraud. I live in a state where the insurance companies are allowed to rule out the body part, not just the condition. So if 6 months from now, kiddo got shot in the lung and had emergency surgery, the ins company could say that by not divulging that kiddo had asthma (although, even by their 5-year rule, it doesn’t qualify), they are not responsible because, had they known of the pre-existing condition, they would not have insured that body part. But again, kiddo doesn’t actually have asthma. See my dilemma?</p>
<p>ETA-- just turned 19yo</p>
<p>Yep, I sure do. It sucks. You have to give them the information, because it’s even worse than you’re thinking. Insurance companies have been known to drop subscribers even if the new expensive condition has nothing to do with the condition that wasn’t disclosed. Like dropping a subscriber who gets breast cancer because she didn’t reveal a foot problem. They don’t check all that carefully when you apply because they want your money; it’s only when you get really sick that they go back and do detective work. (This practice is illegal, but that doesn’t stop them.) They’ll do anything to avoid paying a claim, so you can’t give them the excuse.</p>
<p>The reason I asked when he turned 19 is because when he turns 19.5, he’d be eligible for the PCIP (in my state), assuming he’s uninsured for those six months and is turned down or offered an exhorbitant premium.</p>
<p>The other thing I can suggest is to contact a broker. Ours really helped us to navigate this very complicated situation. They don’t charge for their services.</p>
<p>Ugh! I’ll try to find an insurance broker. It never really occurred to me to use them for health insurance. Thanks.</p>
<p>For us, we got S insurance under his U, since he was aging out (turning age 22) under H’s plan. The school insurance covered him for about a year, Late Aug to early next Aug. When it was set to lapse, I inquired with OUR BCBS plan about whether they had any plans we could purchase for our S (who has a long history of asthma & other chronic health issues. </p>
<p>Our BCBS reluctantly agreed they would cover S with a significant deductible and less favorable terms than is available under H’s plan. If your S is a full-time student, ask his U what coverage/insurance they offer. It helped S that he had ALWAYS been covered by one BCBS plan–H’s plan is that, as well as the insurer the U had. Because he had no gaps in coverage, they agreed to take S & premiums were about $300+/month or so. It was our safety net until under the healthcare reform act, in 1/1/2012, S was able to be covered under H’s plan again.</p>
<p>Can he get a certificate of insurance from the state plan he was under? This can often prevent the waiting period for pre-existing condition coverage. </p>
<p>My daughter starts health coverage through her new employer on Sept. 1 (thank God, since we lose our health coverage Sept. 31). Since she has a certificate of insurance, her asthma, polycystic ovarian syndrome, hypothyroid and sleep apnea will all be covered immediately.</p>
<p>I’m no expert, but I have just been through the process of applying for individual Blue Cross/Blue Shield coverage. My doctor had checked a number of “diagnosis” boxes over the years – because, frankly, that’s how they get approvals and reimbursements. If they want to run more frequent tests just to monitor something, they have to give it a diagnosis code.</p>
<p>None of of this was cited as a “pre-existing condition” on my new coverage. None of it kept me from getting the preferred rate for healthy low risk people, including my prescription for thyroid supplement.</p>
<p>I would just say “no”, he hasn’t been treated for anything in the last five years. If there is a place where it is appropriate to indicate the asthma diagnosis, you can also put the end date of condition and probably note that the inhaler was never used; no symptoms ever occurred.</p>
<p>I was much more worried about “pre-existing conditions” than I should have been. As is often the case, the media makes it seems like something is much more than it really is for most people. Even if they counted something a pre-existing condition for a 19 year old, it’s only going to mean they won’t cover treatment of that condition for “x” number of months. This is probably not a big deal unless the preexisting condition is a major illness, like a cancer diagnosis.</p>
<p>The insurance companies vary in their treatment of conditions from state to state. I spoke to the health insurance expert in our office and she said,
“If it has been diagnosed - and she filled the Rx! - it would need to be filled out yes. That being said in the last 5 years if there has not been any diagnosis or treatment, the 5 year question would be no.”</p>
<p>Does that help? And yes, I would always apply through for an individual plan through a broker, you get someone who understand the system and can advocate for you & help you interpret the questions accurately.</p>
<p>What state are you in?</p>
<p>I was diagnosed with T2 diabetes while uninsured. When we got health insurance through my H’s new employer shortly thereafter, I was expecting the worst. But they simply paid for my diabetes-related expenses–which are very minor–without a peep.</p>
<p>The conventional wisdom in diabetic circles is that if you are uninsured and suspect you might be T2, you should get insurance before having any tests that might reveal it. But it wasn’t an issue for me. On the other hand, I was included in a group, not applying independently. That is probably key.</p>
<p>When I was applying for S on-line (very, very long application), he was rejected because he has asthma & another chronic health condition, even though he hadn’t received any treatment for it in many years prior to the application,</p>
<p>I got a certificate of insurance from the university policy he had held & presented it to our medical insurer (who had covered him under H’s policy) & asked them what options they could offer him. They were the only ones who would offer him a policy because they said there was no gap in his coverage & they were a BCBS & the plan the university covered him under was also a BCBS plan. The HMO (Kaiser) declined to cover S because he had chronic health conditions, no matter how long ago they were diagnosed and how little treatment he had required for it. He made no claims until he went back under H’s policy 1/1/2011. Thanks again for the Health Care Reform Act!</p>
<p>Yes, Consolation, that’s key-- Clinton got rid of the pre-existing condition restrictions on group policies-- but we have no group to which we can belong. </p>
<p>interesteddad, I know this varies by state. In my states, insurance companies can rule out the entire body part and I had them once do this when I applied another kid for a policy.</p>
<p>I saw a health insurance policy rate up a client based on thyroid treatment. Same company (BS) had never rated that condition up in other states. Thyroid is a total no brainer, you can get the best discounted rates on life insurance and on other BS policies in other states, but this one state rated it up. It’s hard to predict what they do and why</p>
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<p>We’ve had a very different experience. DH was diagnosed with high cholesterol and high blood pressure years ago. He takes medication and watches his diet, and both have been in the healthy range since shortly after the diagnosis. But as I said above, it matters not that the condition is successfully treated. It’s the diagnosis.</p>
<p>Would you call well-controlled blood pressure and cholesterol a “major illness” akin to cancer? Blue Cross believes that those conditions are “major” enough to warrant a 50% increase over the base rate for healthy individuals. We got lucky – we were included in a class action settlement against Blue Cross. If not for that, our bare-bones insurance premium would now be higher than our mortgage payment. </p>
<p>That is a VERY “big deal.”</p>
<p>ETA – And you’re awfully casual about the insurance prospects for millions of cancer survivors. Are they just out of luck?</p>
<p>I work with medical insurance, and the policies vary from state to state as to what can be excluded, and for how long the exclusion will exist. In my state the exclusion generally can not be carved out permanently. The look back is a good deal shorter than 5 years, as well. In our state, there are no preferred tiers - we all pay quite a lot- healthy or not. Individual policies are costlier for the same person than he/she would have in a group. It is my understanding that groups are rated on the whole group’s experience. Our own group is a small group, and if we have a couple of people with a lot of claims, our rates will go up. </p>
<p>I would look at the question carefully, and in deciding whether it is a preexisting condition, I would look at the wording of the question. Does it ask if he took rx or saw a medical practitioner? If he has not seen a doctor "for the condition"or filled an rx for it, or been otherwise treated for the condition, then, in my state, that would not be a preexisting condition for most purposes.</p>