About to get insurance, worried about Pre-existing terminology

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SunnyInFLA
SunnyInFLA Member Posts: 27
edited June 2014 in Employment, Insurance, and Other Financial Issues

I am having issues with my right breast, It is significanly larger then the left and during self breast exam I am seeing a very prominet puckering or "dimple" on under side while lifting my arms and bending over as well. 

So here in lies the situation, I have no insurance as of today. I have not had insurance for 2 years actualy. My husband recently got a job and the insurance kicks in next Thurs. The first.

I read this about HIPAA "Can a plan deny benefits for chronic illnesses or injuries, like carpal tunnel syndrome, diabetes, heart disease, and cancer using a preexisting condition exclusion?
It depends on whether you received medical advice, care, diagnosis, or treatment within the 6 months prior to enrolling in a new employer's plan. If you did, you can be subject to a preexisting condition exclusion"

So if I walk in day one of the new insurane to a breast diagnostic center explaining my symtoms would they consider that a pre-existing.. I am not sure if I am explaining this right.. but I am in fear that they will say "well you had symptoms 3 months ago, which means it is pre-exesting" or does do I fall in to the "safe" zone because  I have not went to a dr reguarding my symptoms and have not been "ofically" diagnosed?

I did call the breast diagnostic center and they asked if I ever had any prior breast conditions I said yes (fibrocystic) and was informed I needed a referral.. but my insurance does not require one so should I just break down the door in desperation for someone to look at me the very day I get the insurance? Or go through the channels, which may delay diagnosis? 

Any Advice would be appreciated.

Thanks!  

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  • FLwarrior
    FLwarrior Member Posts: 977
    edited November 2011

    Hi Sunny, Sorry you have to be here...You will find this is great group of ladies with lots of knowledge they are so willing to share! 

    I was also without insurance and when I found my "problem".  It was a very scary time for me.  In my case this is what I did.  When I did finally have insurance, I called the breast center in my area that I knew I would want to use, if needed, to find out where I should start.  They told me that I would need to be referred, just the same that you have experienced.  I asked for the names of some of the gyn drs. in the "network".  I made an appointment with on of the gyn's.  When you call to make the appointment, tell them you have a found a problem and they will give you an appointment sooner rather than later.  Gyn did the exam and gave me a referral that day to get a diagnostic mammogram and ultrasound.  That resulted in another appointment for a biopsy (on a Friday) by Monday morning I had a diagnosis.  At that point I was referred to the breast surgeon. It all happens very fast.  I never had a problem with the insurance paying for tests, treatments or Dr bills. 

    I wish you the best.  I see you are in FL, so am I...You are welcome to PM me with any questions.

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  • SunnyInFLA
    SunnyInFLA Member Posts: 27
    edited November 2011

    Great, I am in TampaBay too.. So health insurance does not care how long you have had symptoms for but rather it was actually diagnosed?? That is very good to know. I am super anxious and I would go this next week if I could but I know if something is wrong it is best to have insurance and not get so hasty in needing to know right this second vs two weeks from now. Thanks again. 

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  • jessicav
    jessicav Member Posts: 161
    edited November 2011

    Sunny in LA- Be careful here. You cannot have bee treated, diagnosed or been given care for that problem or illness. PM me if you like. I think it's for the six months before the new insurance began. 

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  • SunnyInFLA
    SunnyInFLA Member Posts: 27
    edited November 2011

    To clairify I have not went to the DR at all or talked to ANYONE about this condition so far, but it has been present. 

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  • leaf
    leaf Member Posts: 8,188
    edited November 2011

    Just to give a bit of perspective here - most (not all, but most) breast cancer is usually relatively slow growing.  For most breast cancer, they think it has been in the breast for some 4-8 years (not a typo) before it is big enough to be detected by *any* means.

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  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited November 2011

    I think it goes by actual diagnosis, not symptoms.   As soon as you get insurance, make an appt to see an ob gyn.   From there, they can get you a script for an ultrasound/mammo and you can go from there.   You also have a little more protection under a group plan (i.e. your husbands plan), than if you had an individual one.

    I would be very surprised if you encountered any problems since you have never really had a diagnosis.   I don't know if I would mention the fibrocystic breasts - if it were me, I wouldn't .  Does that qualify as a "disease"? 

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  • Medigal
    Medigal Member Posts: 1,412
    edited November 2011

    Well I think you are one of the "rare" people the gov's stupid PCIP with it's "6 month no insurance clause" could actually help.  Since you have not been insured for approx. 2 years you could qualify to purchase the new PCIP insurance plan which each state is supposed to have and it covers pre-existing  diseases.  You might want to check on how much it would cost to purchase it and when you can get on your husband's plan (which should be much cheaper) you could cancel it.  At least you would be insured for whatever medical costs you may incur until hubby's plan kicks in.  You can look up PCIP on the internet and go to your state and actually see the cost for your age group.  Just another option.

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  • SunnyInFLA
    SunnyInFLA Member Posts: 27
    edited November 2011

    OK so now I may be able to get a script written in advance for an U/S and mamo on the first day that my insurance kicks in according to the diagnostic center, they are going to contact my OBGYN and see if she can write one. So now I a worried this be considered pre-existing if the date on the script was written in advacne of the day the insurance goes in effect even if I never saw the doctor who wrote it. The lady at the breast center said no, but I am not sure how much stock I put in that. I would call the insurance company and ask but I don't want to put up any red flags.. HELP

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  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited November 2011

    Sunny, I would get a new script with a new date just to be safe.

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  • ibcmets
    ibcmets Member Posts: 4,286
    edited November 2011

    I thought they go by diagnosis date. I'm not a lawyer, but if you have not had any tests done; they can not diagnose you. 

    Terri

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  • SunnyInFLA
    SunnyInFLA Member Posts: 27
    edited November 2011

    The OBGYN office made a script for me today, after the diganostic center called them for a script and after I talked with them this morning asking if I could get in sooner (after the insurance kicks in but before my reg scheduled OBGYN appointment on the 8th) to see the doctor so she could write me one. The date of the script is today, and it is in the computer, and if the insurance company comes a pokin' which they would if something is wrong they are going to see whatever is in the notes about my called in symptoms and the script referral. Too late now. 

    HIPPA says Medical Advice or Diagnosis 6 months prior is considered pre-existing. I did not get any advice, and I did not get a diagnosis.. I hope to God I am safe. .and they don't come back and say. They doctors office said I should get an ultrasound when I get my mamo (not the doctor, just the nurse on the phone), and that is advice.. man, I am scared. I wonder if "medical advice" means what she told me OR, something like.. I was seen by the doctor.. ei ei ei

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