I applied for individual insurance last
week and was approved, my plan becomes
effective in 2 weeks.
I think I may have a herniated disc or
spondylolisthesis. I had mild symptons for
the last 3 months and acute for the last 3
weeks. It was my own ignorance that caused
it because I felt very mild sciatica and
kept jogging and lifting weights through
the pain until it got quite severe. I came
to the conclusion it was a disc problem
after the sciatica pain didn't go away
after 3 weeks of rest. I don't have any
back problems on my medical record so I
didn't say anything about this sciatica
when I applied. I want to go to my doctor
to get a diagnosis, but I am in the
waiting period between approval and the
effective date.
Should I go to the doctor right now and
get a diagnosis and then call the
insurance company and tell them? Do you
think they would change my approval to
denied?
Or should I wait 2 or 3 weeks and go to
the doctor and say the pain started a
couple days ago? Or say it was just a
slight tightness in my hamstring for 3
months but didn't bother me until now?
I will be paying myself no matter what
because it's a high deductible, but I
wonder if worse case scenario, I might
need surgery later. They say they won't
pay for pre-existing conditions for the
first 12 months. In any case I need health
insurance in general anyway.
I really have no idea what to do.
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DoorIn
New User, Becoming EHEALTHy
Joined: 16 Aug 2007 Posts: 24 Location: Coral Springs, Fl
Posted: 09-22-07 08:01am
It will most likely be considered a
pre-existing condition, whether or not you
received a diagnosis from a medical
professional. Most questions don't just
ask if you've been diagnosed, but ask if
you received symptoms, diagnosis and/or
treatment. “Symptoms” is the key word
here.
I would suggest reading the definition of
a pre-existing condition in your policy
information.
As a technicality, most insurance
companies are looking for pre-existing
conditions at the time of application.
Not between the time of application and
the effective date. People sometimes
apply 1 ½ months in advance. Anything
can happen in that time. If you come down
with a condition after an application, how
can you help that?
What will look most suspicious is that you
didn’t have coverage and then as soon as
you got it, you started submitting claims
for your back.
Also, a health insurance plan is always
contestable. Basically, what this means
is if the insurance company were to find
out there was a non-disclosed pre-x, they
have the right to rescind the policy and
send you a refund check for the premium
amount.
On another note, it’s your health! Get
treatment as soon as possible to prevent
things from getting worse.
As a technicality, most insurance
companies are looking for pre-existing
conditions at the time of application.
Not between the time of application and
the effective date. If you come down with
a condition after an application, how can
you help that? People sometimes apply 1
½ months in advance. Anything can happen
in that time.
