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I'm really hoping someone can answer this question for me. Here's the situation.
I've had knee pain for about six months. It first started when I was working overseas in Europe and I was insured, but I never got it looked at, since I was preparing to move back to the US, and I thought it probably wasn't serious (inflammation or something minor).
Then a couple of months ago, I move home to Minneapolis without a job, and the knee pain is getting worse with time, so I'm thinking that I should get it looked at, but I don't have any insurance. So I ask for a Health Partners application, a bit apprehensive about what questions they'll ask. I was pleasantly surprised to see that they never ask general questions like: "are you sick?" or "do you have any pains?". They only ask if you've ever been treated by a doctor for diabetes, cancer, this, that and the other thing.
Well, I've never had so much as a broken bone, and I've never been treated for any illness, so I answered - completely truthfully - that I've never treated for my knee pain or anything else.
So now, thinking myself insured, I decide to visit the doctor, and he suggests that I get an MRI, which shows a torn meniscus (sp?). I had that operated on two days ago. Also, during the pre-operation physical, the doctor suggested that I have a potential hernia which I should get looked at, for which I'm seeing a specialist later this week. FYI, I've had a bulge in my abdomen forever, but never considered it worrying. The doctor disagreed.
So I'm coming to the end here (thanks for staying with me). Today I get a form from the insurance company (Health Partners) asking questions about my knee pain and when it started. I'm concerned that they're going to say that it constitutes a pre-existing condition, and cancel the insurance, and then I'm not sure if I should continue with the hernia operation (being unemployed, I can't handle the full bill alone for both the knee and the hernia).
So, quick summary: I had knee pain for which I'd never seen a doctor before I signed up for Health Partners insurance. I answered the application truthfully and was enrolled in their plan. Can they now refuse to help pay for the knee or cancel my insurance based on a pre-existing condition? Thanks.
Last edited by allerretour; 12-02-2009 at 05:31 PM..
Reason: Random characters.
They can cancel your insurance or refuse to provide payment for anything related to your knee pain.
I saw a story of a woman who was approved for health insurance despite having breast cancer in the past. Long story short, she had surgery and her insurance company canceled her coverage retroactively and she was left with a $300,000 bill.
Sometimes it's cheaper to have surgery outside the U.S., that's always a thought. I know you're in pain now but maybe you can save up for a cheaper surgery in another country.
Thanks for the reply, Purplelove, but how knowledgeable are you in this area? I admit that I am not very knowledgeable (which is why I'm here asking questions), but I'm not sure you're right.
We agree in that we think they can refuse to pay for pre-existing conditions. The question is: what constitutes a "pre-existing condition"? They never really spell it out clearly on their marketing materials (intentionally, I'm sure), but I saw a web site or two that indicated that a pre-existing condition is only something for which you've sought medical advice (i.e. visited a doctor). Once again, I've never seen anyone regarding the knee. They can't just make up rules regarding what is a pre-existing condition, otherwise someone could develop a stomach cancer and they could say: "well, have you had stomach aches in the past? if so, it's a pre-existing condition." Like I said, I think that pre-existing means "previously treated".
Anyway, you might be right, but I'm still a bit skeptical. Do you have much experience in this area?
If there is no record of your having been treated for the knee injury previous to getting insurance, they can't nail you for a pre-existing condition, UNLESS the doctor notes additional damage from not having it seen quickly. I would blame it on a very recent accident. My son just tore his meniscus playing baseball. I'm not sure how you could have torn it without knowing you did something, that's painful!
The hernia thing is trickier. Technically, it IS a pre-existing condition, although one you weren't aware of. I would confirm coverage in writing before going ahead with the surgery. I personally don't trust insurance companies at all right now.
How does your insurance company define pre-existing? Look at your policy details and it should contain the answer. If the definition is previously treated and there is no time limit on seeking care for an injury or sickness you may be covered.
"How does your insurance company define pre-existing? Look at your policy details and it should contain the answer."
That's the problem. You'd think that it would address that directly, but it doesn't. I've looked through the policy about 10 times and you never see the term "pre-existing coniditon". What it does say is that they can cancel the policy if you gave false information on the application. But, like I said, all of the questions on the application were pertaining to past TREATMENT. Things like: "Have you ever been treated for cancer?", "Do you take any medications for high blood pressure?", etc, etc At the time I filled out the application, I just had a sore knee that I suspected had some problem, but I wasn't sure what.
I think that they are intentionally vague in their policy to keep people in the dark.
They can cancel your insurance or refuse to provide payment for anything related to your knee pain.
I saw a story of a woman who was approved for health insurance despite having breast cancer in the past. Long story short, she had surgery and her insurance company canceled her coverage retroactively and she was left with a $300,000 bill.
Sometimes it's cheaper to have surgery outside the U.S., that's always a thought. I know you're in pain now but maybe you can save up for a cheaper surgery in another country.
I call BS on your story... NO hopsital/doctor is going to do $300,000 worth of care without having the patients insurance pre-authorized...
Thanks for the reply, Purplelove, but how knowledgeable are you in this area? I admit that I am not very knowledgeable (which is why I'm here asking questions), but I'm not sure you're right.
We agree in that we think they can refuse to pay for pre-existing conditions. The question is: what constitutes a "pre-existing condition"? They never really spell it out clearly on their marketing materials (intentionally, I'm sure), but I saw a web site or two that indicated that a pre-existing condition is only something for which you've sought medical advice (i.e. visited a doctor). Once again, I've never seen anyone regarding the knee. They can't just make up rules regarding what is a pre-existing condition, otherwise someone could develop a stomach cancer and they could say: "well, have you had stomach aches in the past? if so, it's a pre-existing condition." Like I said, I think that pre-existing means "previously treated".
Anyway, you might be right, but I'm still a bit skeptical. Do you have much experience in this area?
Sorry for my late reply.
I don't have a lot of experience in the area but I've done a lot of research in the area of the practices of the health insurance industry.
I've read plenty of articles, watched documentaries, etc.
Sometimes acne can be a pre-existing condition.
I agree you're right about pre-existing meaning "previously treated."
At the same time, a pre-existing condition can be something congenital that was never treated. I volunteered in a hospital in the clerical department. I've seen insurance companies refuse to pay for things because they saw it as "congenital." Maybe it's just another term for pre-existing. ::shrug::
"How does your insurance company define pre-existing? Look at your policy details and it should contain the answer."
That's the problem. You'd think that it would address that directly, but it doesn't. I've looked through the policy about 10 times and you never see the term "pre-existing coniditon". What it does say is that they can cancel the policy if you gave false information on the application. But, like I said, all of the questions on the application were pertaining to past TREATMENT. Things like: "Have you ever been treated for cancer?", "Do you take any medications for high blood pressure?", etc, etc At the time I filled out the application, I just had a sore knee that I suspected had some problem, but I wasn't sure what.
I think that they are intentionally vague in their policy to keep people in the dark.
Well of course they are, that's how they make money at our expense.
I will trust you when you say nothing is in writing but I find that to be totally out of character for a health insurance policy. The only thing I can think to tell you then is that when you do go to get treatment don't offer that the pain has been bothering you for too long.
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