Could my insurance drop me after testing

Ally1969 · October 2008

My OB/GYN recommended today that I undergo genetic testing because of my strong family history of breast and other cancers. But she went on to say I need to check with my insurance company, because if I test positive for the BC gene, my insurance company could drop me and my coverage completely, or at the very least refuse to pay for any further breast issues if I'm positive because that would be pre-existing. Anyone else heard of this?

Anonymous · October 2008

There is a new Genetic Information Nondiscrimination Act bill that has been signed into law, but the new rules for insurance companies don't go into effect until June of 2009:

http://hr.blr.com/news.aspx?id=78371

The GINA bill states that, "Group and individual health insurers are prohibited from using genetic information to determine insurance eligibility. Increasing an insurance premium based on genetic information is also prohibited." Just keep in mind that insurance companies are not required to comply with new law until June of next year.

Talk to your doctor, and see if she is comfortable with you waiting until June to have the testing done. If not, you can always talk to your insurance company and ask what their current policy is. Not that I don't trust insurance companies, but if they tell you that a positive outcome of genetic testing won't affect your insurance coverage at all - I'd ask for that in writing.

Good luck!

Dukemom

leaf · October 2008

A relative, who is a genetics counselor (for pre-natal issues, not for cancer) said that what they sometimes advise people is - if this is possible - to pay for the genetics testing out of pocket. If its negative they bill their insurance. (Some insurance companies won't pay for it anyway.)

All good quality genetics testing programs that I have heard of require genetics counseling before genetics testing. When genetics information is addressed by state law, I think different states can have different rules. When the federal law goes into effect, that should, of course, apply to the whole country. I would definitely ask about this when you go to your initial genetics counseling meeting.

I got genetics counseling, and opted to not get testing (because my risk was low.) I found it very helpful.

I think on the FORCE website, they often recommend getting a board-certified genetics counselor. I think there are some genetics programs where the patient gets tested without counseling, but I would avoid them. You need to know all the ramifications of testing before you get tested. Then make your decision that is best for you. Any genetics counselor worth his/her salt should not be pushing you for or against testing.

Emily2008 · October 2008

I've received genetic counseling and am considering having the test done though my risk is low. This is mainly b/c I'm going to have add'l surgery next year and will consider a prophylactic mast on the other breast if I am positive.

My counselor told me that many states have already passed the law, and like Leaf said, the federal law will go into effect in May (she told me May), and it will cover all states. My state has the law already and right now it should protect me b/c I'm in a group health ins plan. If it is a private plan (i.e. you bought it yourself), you may not be protected until May when the federal law goes into effect. The lab that does the test gets your sample and will verify your benefits with the ins company. If your out of pocket is less than $375 (approx 10% of the cost) they will automatically run the test. If it is greater than $375 they will hold your sample and call you to see ifyou want them to run it. I'm on the fence about it but need to make a decision fairly soon.

HTH! BTW, I would speak with a genetics counselor to assess your risk. It's more complicated than you may think. I certainly thought so!

Anonymous · October 2008

Your insurance company CAN NOT drop you. Under current Federal Law, insurance companies can not drop people simply because they have been diagnosed with a disease, therefore that you might someday be diagnosed with a disease can not be used to terminate your insurance. The only way it can terminate your insurance is if you don't pay your premium commit misrepresentation on your application. Additionally, under most State laws insurance companies can not raise premiums simply because they do not like your profile, but there are exceptions.

My wife had the Brac test and we just arranged so that nobody could find out the results, in fact the results were told to us in confidence. The only way that information is released is if you allow it to be released.

Mutd · October 2008

Ally, if your insurance company had a mindset (or procedures) of this sort, they would have dropped you already, just because of your strong family history of cancer which indicates that you're a high risk patient. All the gene test does is to narrow down the risk group.

But the health insurance companies understand that it is not worth the PR risks to deny coverage based on family history. And that it helps their companies' bottom line to narrow down the groups of risk. So there is this fear of loosing health coverage, but not the real stories to stoke the fear. Of course after GINA kicks in next year, there won't be any reasons left to fear anymore.

Keep in mind that GINA does not address life insurance. So far, life insurance companies haven't tried asking people about their mutations yet. But just to play it safe, you may prefer to get life ins before testing.

Jo_Ann_K · October 2008

Wow..this is a subject I have just checked into myself since I had my genetic testing this week. The geneticist advised me that not only can you NOT be denied insurance for a positive test, but you CANNOT be denied employment either based on the new federal legislation just passed that was mentioned above.

Pertaining to the privacy of the medical data. Every health care organization that gets paid by an insurer has a contractual relationship with that insurer that enables the insurer to view your records if they are in relation to payment for your health care. That's part of the HIPAA law.

So while you have some level of privacy pertaining to other health care providers who are not directly treating you, you really do not have total privacy for companies paying for your health care.

That's why it's a good idea to read the Notice of Privacy Practices that every health care provider or organization should give you prior to giving you care. It's amazing what you read there! Yet, most of us just sign the document, because the font is too small to read; it takes too much time to read; and we're pushed by personnel to sign it quickly.

Regards,

Jo Ann from Maryland

Riley5 · October 2008

Blaest is correct, under current federal law, insurance companies cannot drop you due to a positive genetic test, however, it only applies to "group" policies and not individual policies. I have an individual policy and had the pay the $3200 out of pocket a couple of years back. I assuming the bill that Dukemom mentioned is a change to include "individual" policies.

Anonymous · October 2008

Individual policies CANNOT drop people because of a negative diagnosis. They don't have to provide coverage to begin with or can exclude conditions but once insured, you are insured so long as you pay your premium and so long as there was no misrepresentation in the last two years or so on your policy of insurance. It would be a hell of a mess in an insurance company could drop from their policies people diagnosed with life threatening conditions.

Anonymous · October 2008

Here is the Law:

United States Code

________________________________________________________________________________

TITLE 42 - THE PUBLIC HEALTH AND WELFARE

CHAPTER 6A - PUBLIC HEALTH SERVICE

SUBCHAPTER XXV - REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE

PART B - INDIVIDUAL MARKET RULES

SUBPART 1 - PORTABILITY, ACCESS, AND RENEWABILITY REQUIREMENTS

________________________________________________________________________________

42 U.S.C. § 300gg_42. Guaranteed Renewability of Individual Health

Insurance Coverage.

(a) In general - Except as provided in this section, a health insurance

issuer that provides individual health insurance coverage to an individual

shall renew or continue in force such coverage at the option of the

individual.

(b) General exceptions - A health insurance issuer may nonrenew or

discontinue health insurance coverage of an individual in the individual

market based only on one or more of the following:

(1) Nonpayment of premiums - The individual has failed to pay premiums or

contributions in accordance with the terms of the health insurance

coverage or the issuer has not received timely premium payments.

(2) Fraud - The individual has performed an act or practice that

constitutes fraud or made an intentional misrepresentation of material

fact under the terms of the coverage.

(3) Termination of plan - The issuer is ceasing to offer coverage in the

individual market in accordance with subsection (c) of this section and

applicable State law.

(4) Movement outside service area - In the case of a health insurance

issuer that offers health insurance coverage in the market through a

network plan, the individual no longer resides, lives, or works in the

service area (or in an area for which the issuer is authorized to do

business) but only if such coverage is terminated under this paragraph

uniformly without regard to any health status_related factor of covered

individuals.

(5) Association membership ceases - In the case of health insurance

coverage that is made available in the individual market only through one

or more bona fide associations, the membership of the individual in the

association (on the basis of which the coverage is provided) ceases but

only if such coverage is terminated under this paragraph uniformly without

regard to any health status_related factor of covered individuals.

(c) Requirements for uniform termination of coverage -

(1) Particular type of coverage not offered - In any case in which an

issuer decides to discontinue offering a particular type of health

insurance coverage offered in the individual market, coverage of such type

may be discontinued by the issuer only if -

(A) the issuer provides notice to each covered individual provided

coverage of this type in such market of such discontinuation at least 90

days prior to the date of the discontinuation of such coverage;

(B) the issuer offers to each individual in the individual market

provided coverage of this type, the option to purchase any other

individual health insurance coverage currently being offered by the issuer

for individuals in such market; and

(C) in exercising the option to discontinue coverage of this type and in

offering the option of coverage under subparagraph (B), the issuer acts

uniformly without regard to any health status_related factor of enrolled

individuals or individuals who may become eligible for such coverage.

(2) Discontinuance of all coverage -

(A) In general - Subject to subparagraph (C), in any case in which a

health insurance issuer elects to discontinue offering all health

insurance coverage in the individual market in a State, health insurance

coverage may be discontinued by the issuer only if -

(i) the issuer provides notice to the applicable State authority and to

each individual of such discontinuation at least 180 days prior to the

date of the expiration of such coverage, and

(ii) all health insurance issued or delivered for issuance in the State

in such market are discontinued and coverage under such health insurance

coverage in such market is not renewed.

(B) Prohibition on market reentry - In the case of a discontinuation under

subparagraph (A) in the individual market, the issuer may not provide for

the issuance of any health insurance coverage in the market and State

involved during the 5_year period beginning on the date of the

discontinuation of the last health insurance coverage not so renewed.

(d) Exception for uniform modification of coverage - At the time of

coverage renewal, a health insurance issuer may modify the health

insurance coverage for a policy form offered to individuals in the

individual market so long as such modification is consistent with State

law and effective on a uniform basis among all individuals with that

policy form.

(e) Application to coverage offered only through associations - In

applying this section in the case of health insurance coverage that is

made available by a health insurance issuer in the individual market to

individuals only through one or more associations, a reference to an

"individual" is deemed to include a reference to such an association (of

which the individual is a member).

(July 1, 1944, ch. 373, title XXVII, Sec. 2742, as added Pub.L. 104_191,

title I, Sec. 111(a), Aug. 21, 1996, 110 Stat. 1982.)

EFFECTIVE DATE

Section applicable with respect to health insurance coverage offered,

sold, issued, renewed, in effect, or operated in the individual market

after June 30, 1997, regardless of when a period of creditable coverage

occurs, see section 111(b) of Pub.L. 104_191, set out as a note under

section 300gg_41 of this title.

Anonymous · October 2008