Short Term Medical Plan

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Lilkrazy4404
Lilkrazy4404 Member Posts: 14
edited March 2016 in Employment, Insurance, and Other Financial Issues

I just recently had biopsy done results came back benign, all is good there. But I would like to get a second opinion. I didn't have insurance when the biopsy was done and results came in. Now I just got a Short term medical plan, I'm not sure if they will consider this a pre-existing condition or not? I am self-employed which is why I didn't have insurance before, it was out of my price range. I also missed the open enrollment which is the reason why I got short term medical for right now. This biopsy scared me into getting something in place.

Should I start the process over, go to my primary dr. ask for a mammo and go from there? Or just call around for a second opinion. Insurance has my mind spinning. LOL

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  • LisaAlissa
    LisaAlissa Member Posts: 1,092
    edited March 2016

    Your insurance policy's terms will govern whether or not it offers you any coverage on a second opinion following a benign-result biopsy. And how much time needs to be elapsed (if any) before it won't be considered a pre-existing condition.

    I would suggest that you don't go for a "second opinion." I suspect starting the process over will yield a better result. And in fact, if you can wait a bit, and find a "new" or "recently resumed" symptom, it will probably be better.

    However you need specific advice on your policy. Call your state insurance department and ask where you can go to find help in interpreting the terms of your policy. They may well have a consumer specialist there who can help you. If not, they may be able to refer you.

    Every state has a plan for mammograms/treatment of the uninsured/underinsured. In some states they will only aid in financing treatment for those whose mammograms discovering the problem were done through their program. So you'll want to see if you're eligible for that program before you have another mammogram!

    Best wishes!

    LisaAlissa

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  • vlnrph
    vlnrph Member Posts: 1,632
    edited March 2016

    I was under the impression that, in the US, the ACA/Obamacare eliminated the pre-existing condition exclusion. You may be paying more in premiums for a short term policy but should have coverage for screening mammography, probably at no cost. Diagnostic testing however, with extra views, etc. is billed differently.

    Do you want another lab to review the pathology slides? Or perhaps you're concerned that the biopsy did not sample the correct area. I agree with Lisa that it might not hurt to wait a couple months then start over, maybe at a more specialized breast care clinic or academic medical center which is in your network.


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