Is DCIS considered a "pre-existing" condition?

Janets1

Is DCIS considered a "pre-existing" condition?

Janets1

Hi Everyone:

I was treated last year for DCIS when I was covered by a group insurance policy. Since then I have lost my job and will soon need to consider buying my own health insurance if I don't find full-time employment. I have not noticed DCIS specifically listed as a pre-existing condition on the insurance websites I've been looking at,  but wonder if the underwriters will consider it to be breast cancer, thus making it impossible for me to obtain insurance. Although I consider myself fully cured (my 6 month follow up mammogram came back just fine), I wonder what the insurance companies will think. This is probably important information for many of us who are in the same boat. I am 61 with no other health issues. Would love to hear from anyone who might have an answer or any idea where I can get this information. I am still on COBRA so don't want to apply for insurance yet. Thanks!

CrunchyPoodleMama

Great question... I've wondered that myself and look forward to hearing the replies!

Kitchenwitch

Janets1, I think anything can be a pre-existing condition, but you should be all right as long as you're on COBRA. I don't know all the technicalities but one of the goals of health care reform was to eliminate exclusions for pre-existing conditions. 

Check this for a sketchy rundown on what it all means. The provisions don't go into effect for a few more years, but those with serious health problems will be eligible to go into high-risk pools. 

My husband and I are still covered under COBRA. I think it's about to expire for us in February, but there's been an extension, so we can probably do that. We'll try to stay in the group insurance market for as long as we can. People run into more problems with denials in the private insurance market. In a few years, you'll be eligible for Medicaid, no?

 Good luck! 

sweatyspice

Anything can be a pre-existing condition.

The way I understand it, the laws vary by state - so it's hard to give a general answer - no idea what the laws are in Illinois.  Some states will allow insurance companies to deny payment on a pre-existing condition forever (this goes away in 2014), some states will allow insurance compaies to deny payment for one year (technically, it's a "waiting period" not a "denial" - that's how they get around it.  The waiting period business is the law in NY, and I'm not quite sure how the health reform legislation addresses it, if it does at all.).

I'm only speaking about NY here, because it's all I know, but in this state you can't be denied coverage for a pre-existing condition as long as you've been continuously insured (more or less, I think you're allowed to have a gap in coverage of 60 days).  You can change plans, but you have to keep some kind of insurance to not fall into the pre-existing "you'll be denied coverage for a full year since your last appointment" trap.

As I said, I'm really not sure what the laws in other states are, but Google should help you find out!  Try your states' insurance department websites, etc.

Also, I believe the COBRA extension you're talking about Kitchenwitch was a NY State extension.  Those covered by COBRA in other states (like me, I live in NY but have a Florida insurance policy - b/c that's where my former employer was headquartered) well, I think people in other states don't necessarily have an extension. 

By Feb 1, I need to find a new plan.  That's when my COBRA expires.  Otherwise, I have 60 days before I'm screwed.

Janets1

Hi!

I know I'm fine on COBRA as that is the continuation of my group plan....but I only have it for 3 more months unless my state (IL) extends the benefit and if the feds continue to pay the 65% of the policy. My concern is in three months I will have to buy my own private insurance if I still don't have a job with benefits. From what I have learned, I can get on a state policy that allows for pre-existing conditions but it is very expensive and there are limited spaces available thanks to this ghastly economy. A slightly less expensive alternative is available through Illinois state but only for those who have been without any health insurance for 6 months. It is just mind boggling and I have an insurance broker who will do the legwork, but even he doesn't know how the underwriters are going to look at DCIS (he had never heard of the condition). So I'm hoping to hear from women who a)had to apply for private insurance after their DCIS was treated and if/how it affected their acceptance or b)someone in the insurance field with knowledge of this rather confusing situation!

Yes, I  can't believe I am looking forward to being 65 and having Medicare!!!!!

IronJawedBCAngel

Yes, as DCIS is considered cancer by most, it will very definitely be considered a pre-existing condition.  I know women who were denied coverage for their breast cancer as having fibrocystic  breast disease before diagnosis was determined to be a pre-existing condition.  I am fortunate to be on my husband's insurance. 

Janets1

That's distressing information!

I think I am going to have to find a husband.....:)

louishenry

Janets,

We tried to switch from Humana to BCBS because our monthly premiums are awful. My husband and kids were approved and I was denied.

Interestingly enough though, I thought I would apply for extra life insurance. I figured "why not?". All they can do is say "NO." I went from 100k to 500k and got the best rates. My policy is with a great company too. I was low risk to them and high risk to BCBS.

I hate insurance companies.

Janets1

I hate them too, ditto, yeah yeah yeah! Louishenry, your story is really one for the books.

I wonder who has had experience with Aetna. My understanding is that they are less likely to exclude pre-existing, particularly if you can prove creditable coverage prior to acceptance.

Hope to hear from more people about this!!! Thanks to all who have replied.....I am taking notes!

CHRISCPA

Janets1 please call a health insurance broker in your area.  The COBRA and HIPPA rules are very specific about health insurance. Once your COBRA is up my understanding is the private insurers have to insure you but you get rated higher because of pre-existing conditions.  A good health insurance broker should be able to review all these issues with you then you can let him (or her) spend their time sifting through the options and come back to you with a plan.  We went through this with our son a few years ago and a broker found him insurance.  Of course it is always best to be on a group plan with pre-existing issues but it isn't always possible.

CTMOM1234

Janets1 - You'd asked about Aetna. We have Aetna and they've been great -- absolutely no problem with them/no problems with any pre-existing condition restrictions (and we switched after my initial dcis diagnosis and before surgery).  My coverage is part of a group plan through work, so this may differ from your options. Good luck

Janets1

Hi CTMom:
 

Thank you for posting!

I've been very happy with Aetna for the most part (yes, as part of group plan)and my broker seems to think I might be able to get individual insurance with them but it might be pretty high.

My understanding is that a group plan through work is not going to deny coverage, which is why so many people work just for insurance. But, in my case, I am now unemployed and finding a job is proving to be very challenging.

Or, there is something about certain pre-existing conditions not accepted for one year, but after that they would take me if I stay healthy!

What I am hoping for is to hear more from women who have applied for individual insurance.....and how their DCIS affected that policy.

lago

I recommend calling up the state plan if you haven't already. I know they told me that I would not have to wait 6 months but to apply at least 60-90 days before the insurance runs out. You will need proof that you have been turned down by at least on private insurance company. I believe it was the phone number on the first link that I called. My cobra is up at the end of April… I just had my BMX 10 days ago and haven't even talked to the oncologist yet let alone started chemo, then drug therapy. Good chance I might need radiation too. Without insurance there is no way I can do this.

Here are some links (for Illinios)

http://www.chip.state.il.us/default.htm 

http://www.healthcare.gov/law/provisions/preexisting/states/il.html 

General link for other states: http://www.cobrahealth.com/statehighriskpools.html

Might also want to check this thread on the forum: http://community.breastcancer.org/forum/113/topic/754874?page=1#post_1933444

and this uninsurable healthcare options: http://www.quotesforinsurance.com/uninsurable-healthcare-options.html

Kitchenwitch

If anyone needs to go through the private insurance market, there was a helpful article in today's NY Times about how to use brokers. If you search the Times website for "insurance" there were some other articles as well that seemed like they might have some good info.

lvtwoqlt

I recently lost my job and my health insurance (BCBS). I didn't really want to go on my husband's policy (BCBS) at twice the price of my policy. I checked out getting a private plan with BCBS and the medical questions that were asked when I was applying for the insurance, but not showing when I did an internet search for pricing, had have you ever had cancer, since DCIS is considered cancer, I answered yes and another question was have you had any breast biopsies (I had 3 in 2 years). I was denied the private coverage but I was able to go on the group plan with my husband's company without any medical questions. I could have picked up the state policy for the high risk pool but the cost was even more than what my husband's group plan cost was. but if I had no other options, I would have had to take the high risk pool insurance.

Janets1

To Lago:

I will take another look at the links you sent, but wanted to let you know that you may be able to get care after your insurance expires in April from Susan G. Komen, Illinois Breast and Cervical Cancer program, or Howard Brown Health Center. Best wishes to you in your recovery and thank you for the information!

Janets1

Dear lvtwoqt:

RE: BCBS: I wonder what would have happened if you had answered the question "Have you ever had cancer" with a "no".....there is another question later that asks if you have had any specific female type of condition and/or breast biopsies and that is the place where you could say "yes" and specify DCIS. I say this not because I don't believe DCIS is cancer.....but one can make the case for it being pre-cancer and, in this case, that is what we have to do to at least try and get the private insurance. Since there are still no definitive answers on this, I am going to take that approach. 

Then, if the underwriter's want to know more about DCIS, they will learn it is "in situ" and go from there.  

 Again, would love to hear from people with this specific situation: Private insurance and DCIS. 

Thanks!!! 

lago

Thanks Janet. Funny for decades I have been donating my clothes to the Brown Elephant (goes to Howard Brown research) and sponsoring friends through the country on Komen walks and runs I never thought I would be using/needing their services.

I would check with the insurance companies to make sure DCIS is not considered cancer. If you answer no and it is then you could end up with more problems. Like, they cover you then deny you although return all your money… then you end up with a lapse in health insurance and need to cover all those months of costs. Oh it can get so complicated. I highly suggest calling and asking the company without giving your name if DCIS is considered cancer, pre-existing condition or basically an unisurable condition.

leaf

What is the Health Insurance Portability and Accountability Act of 1996 (HIPAA)?

<snip>

If you have a preexisting condition that can be excluded from your plan coverage, then there is a limit to the preexisting condition exclusion period that can be applied. HIPAA limits the preexisting condition exclusion period for most people to 12 months (18 months if you enroll late), although some plans may have a shorter time period or none at all.<snip>

 HIPAA:<snip>

• Does not guarantee that any conditions you now have (or have had in the past) are covered by your new employer's health plan; <snip>

• http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

Here's the testimony of a woman who went to a dermatologist for acne, and subsequently had her health insurance policy cancelled when she got invasive Her2+ breast cancer.  She had to wait from June to October to get her surgery, and her cancer grew from 2.3 cm to 7cm during that time.

http://energycommerce.house.gov/Press_111/20090616/testimony_beaton.pdf

Apparently, one guy was told he had to join the high-risk pool because he had a pre-existing condition of toenail fungus. http://myhealthcafe.com/healthcare-reform-is-living-a-pre-existing-condition

So the pre-existing condition can be anything, it seems.

iHEARTu

Recently I've been wondering this...great topic, but so disheartining. If recovery for DCIS is 100% after a BMX, why would it be considered a PEC? Oh well, another thing for folks to not to be covered.

Catherine

mradf

It's not 100%.  It's 98% at best, which is my prognosis following BMX, and which I consider excellent.  My breast surgeon is always careful to remind me of how low my risks are, but without a 100% guarantee.  Even my oncologist would  not put me on Tamoxifen because he could only increase my number by one point to 99%, and not worth the associated risks and side effects. 

The other side to this insurance debacle is that many of the procedures that are covered are because we DO have BC.  I've gone a few rounds with my insurer when they didn't want to cover something or other.  When I was diagnosed, the doctor's words were:  "The test was positive for a malignancy - you have breast cancer".  However tame and early stage DCIS may appear at first, it is still cancer, not to be left untreated. 

From time to time I questioned whether my agressive surgical approach was too much, and then in June I lost my sister to BC.  I know with at least 98% certainty that I saved my own life.

Whatever your situation is, try not to let the insurer get the upper hand.  Learn the insurance laws of your state and the federal regulations.  Keep records with names, dates, and what was discussed.  Copy your congressional representative on important correspondence.  Do not take the word of a customer service representative.  Work your way up the chain.  Ask to speak to the doctor or RN who makes decisions on your coverage.  Ask to speak to the director of the plan.  Stay focused.  Appeal, appeal, appeal.  Be well,

Maria

louishenry

Hi Janets,

I'm not really sure, but I think Northwestern Mutual, who I have my policy with, used NIH guidelines. NIH is the National Institute of Health. They may have called DCIS a "condition."

I realize that many of us call it a "cancer". However, DCIS ranges from "not terribly serious i.e. small and grade 1 ", to "almost invasive."

Either way, like I mentioned I went from $100k to $500k with no problem.

But, my pathology was also very favorable. I did not need radiation and did not have any other issues over the past 10 years.

Nada

Janets1

Amen, amen mradf! The customer service reps are not kept up to date on new legislation and regulations. I was told several times that my mini-COBRA could NOT be extended but after researching like a fiend,  I found out that a bill had recently been signed allowing those on the ARRA subsidy to get extra months. I filed a formal complaint with the state and voila, received a note through the benefits administrator of my former employer that Aetna would extend my benefits an additional 3 months and stating that their legal department had not formally chosen their "stance" on the new regulations but would give me the extension anyway! Puh-leeze. A law is a law but if the insurance companies can get away with shenanigans, they are going to do it. Being informed is so very important which is why I am so grateful to read everyone's comments and experiences. I will say that it is very difficult to go up the chain when you are having a phone conversation or email correspondence with a customer service rep. They very likely think they are doing their job only when they can get rid of an annoying caller without having to turn to upper management. But this is our health and our lives and we have to do what we have to do - which means being the squeaky wheel. 

Kitchenwitch

Janets1, what is mini-COBRA?

Janets1

Mini COBRA is insurance continuation for smaller companies of 20 or fewer employees......so if you worked for a small company, as I did, it's considered "mini" COBRA = fewer months of continuation.

From what I've read, there are actually some states with no continuation coverage for such small companies. Sad. And, if I may just vent about last night's election results....who knows what lies ahead for those of us fighting for insurance coverage?  

Kitchenwitch

Janets1: thanks for the explanation. Am kind of reeling from how unfair that seems. My husband worked for a fairly large company so we have regular-sized COBRA. I am also upset about last night's election results - only paid attention to the NY repub gov one, which is very worriesome. 

lvtwoqlt

about the questionaire, there was a question about have you had multiple breast biopsies (I had to answer yes, one in 2005, one in 2006 both ADH, and one in 2007 with DCIS) it was just a yes/no response, and were they b9. My dr said that DCIS is pre-invasive cancer but still cancer. And if I had answered no to any questions, BCBS could have checked my records (have been with BCBS for many years) and seen the previous biopsies as well as the cancer dx. and I would have been rejected at that point.

Sheila

mradf

I cannot find anywhere NIH calling DCIS a condition, and they seemingly avoid making position statement at all.  They did, however, hold a conference late last year to address it:

http://www.nih.gov/news/health/sep2009/od-24a.htm

Also, despite a very early diagnosis and a very good outcome, I've been treated on all fronts as though I had BC.  Meanwhile, my life insurance agent has been shopping me a new policy all along - and he's aware of the BC diagnosis.  The selling point is that I can do it without any medical.  I'm not certain that means the home office knows, too, and whether they would write a policy if they did know. 

Who can figure any of it?  It's INSURANCE for goodness' sake!  I want to say there's no logic in it, but we all know it's all about the actuarial stuff.

Be well,

Maria

louishenry

Hi Maria,

My mistake- Not NIH, NCI called it a condition. I'm not suggesting I agree or disagree with them, just really happy to get extra life insurance. The point I was trying to make was that life insurance people weren't too freaked when they read all of my medical reports. They were willing to take a chance on me .But no- BCBS were not interested in taking our $2300 a month.

My girlfriend was penalized for being on anti- depressants. They would not cover any future mental heath treaments. UGH!

I still hate insurance companies.

Meow13

I wonder if we will be facing these issues again. Obamacare will be repealed and replaced, it is Trumps top priority.