Insurance coverage!

VeggieGirl · 01-04-2008, 04:31 PM

I have been treated for various symptoms of PCOS for years and it's been documented in my medical chart that I've been on Spiro for hirsutism, BCPs for hirsutism, etc. My old doctor never officially diagnosed me with PCOS because she said she thought it was "mild" and "temporary" and she didn't want me to have the diagnosis for insurance purposes (I wish I had gotten a 2nd opinion but I was young and naive!)

Now, I currently do not have insurance but I'm a college student and I'm using the student health system. I really feel that I need to get treatment and I'm sick of not being formally diagnosed- I have facial and body hair, sporadic periods, acne, and now I'm starting to have noticeable hair loss that I want treated. I've looked into purchasing my own insurance (my part-time job doesn't offer it) but the ones I looked at don't cover "pre-existing conditions". I'm worried that since it's noted in my chart that there are PCOS concerns, they won't cover it if I do get a diagnosis. Or, if I use the student health system for treatment w/o getting a formal diagnosis, will it count as a "pre-existing condition" later on when I get insurance? I don't want to mess this up!

KatCarney · 01-04-2008, 04:50 PM

Your doctor did you a favor, since you currently don't have coverage.

Unfortunately, in many cases, getting a 'formal' diagnosis won't improve your treatment in any measurable way.

If it were me, get coverage before pushing anyone to diagnosis me 'on record'. A diagnosis, coupled with active treatment costs BEFORE coverage can frequently make it difficult to obtain coverage later.

VeggieGirl · 01-04-2008, 05:08 PM

I had excellent insurance then, under my mother's plan. The doctor didn't think I had "real" PCOS because I'm not obese, and she said the facial hair would "go away" after I was finished with puberty. That's why she didn't diagnose me- the mildness of my symptoms (according to her) wouldn't be worth having the official diagnosis over.

I'm worried about getting any more treatment on record before getting insurance, but I'm also worried about not getting treatment for years just b/c I don't have insurance. How long do you think I can continue to be treated "informally" before a future insurer will consider it a pre-existing condition? Or will they never consider it one if I'm never formally diagnosed?

ivetastedflight · 01-04-2008, 05:24 PM

Quote:

Originally Posted by KatCarney

A diagnosis, coupled with active treatment costs BEFORE coverage can frequently make it difficult to obtain coverage later.

Most insurances frown upon "Pre-existing Conditions" and because I had one when I got my current insurance, I had to wait through a 6 month period to get full coverage. It sucked. I would definitely hang tight until you get a decent insurance established.

KatCarney · 01-04-2008, 05:25 PM

Quote:

Originally Posted by VeggieGirl

I'm worried about getting any more treatment on record before getting insurance, but I'm also worried about not getting treatment for years just b/c I don't have insurance. How long do you think I can continue to be treated "informally" before a future insurer will consider it a pre-existing condition? Or will they never consider it one if I'm never formally diagnosed?

Health insurance companies look at several factors when determining coverage.

They want to assess how much money you will cost them.

The longer you wait to secure coverage, while actively being treated for on-going symptoms (for anything), the higher the risk is that there will be red flags when going for coverage.

The sooner you can get coverage (even super, super cheap coverage) the better.

Especially if you're actively being treated by your doctors.

Again, I have to stress, that a formal diagnosis, probably won't change your course of treatment.

VeggieGirl · 01-04-2008, 05:35 PM

Thanks for your input. I'm looking at some student plans that cost around $60/mo- they don't cover much, but they're something.

I think I want the diagnosis for validation, more than anything else. But I know you're right...what I need to do is find a good doctor who knows about PCOS and stick with him/her. Thanks again

KatCarney · 01-04-2008, 05:50 PM

Quote:

Originally Posted by VeggieGirl

I think I want the diagnosis for validation, more than anything else.

For now, I wouldn't worry about it.

Also, keep in mind that PCOS is a diagnosis of 'exclusion'. Meaning that doctors should EXCLUDE several other diseases, and if they still can't find out what's causing your symptoms, they call it 'pcos'.

Until there's a conclusive diagnosis on the books, you really don't want a pcos diagnosis on your record - especially if you don't have health insurance.

bec415 · 01-04-2008, 06:54 PM

It's probably different in every state, but when I was in New Jersey I had to get my own indivdual coverage, I hadn't had insurance for a couple of years. So every time I went to see a doctor, got bloodwork etc. it went under a review process to decide if it was a pre-existing condition I was being treated for. What happened in the end, is I had to pay almost everything myself, even though I never had a formal dx for pcos, hadn't even seen a doctor in over two years, they determined I had been treated for a pre-existing condition??!!

Anyway, be careful of this since you haven't had insurance for a while. If I were you, I would get the insurance if there is a pre-existing clause, wait a year before getting any huge tests done. See if you can get onto spiro to help with your hair loss, acne etc. But if you get any tests run be prepared to have to pay it out of pocket.

VeggieGirl · 04-19-2008, 08:49 PM

I applied with HumanaOne for their "emergency coverage only" plan, and they denied me due to "possible Polycystic Ovarian Disease" and "possible insulin resistance". They apparently got that information from my college health clinic, where I recently had a Pap and some labs done to check my vitamin levels, cholesterol, etc.

This is very bad, I think.

KatCarney · 04-19-2008, 10:02 PM

Quote:

Originally Posted by VeggieGirl

This is very bad, I think.

It's not good, for sure.

Do you have time to work part-time? I think Starbuck's has a fairly generous health insurance policy for part time workers. Many people have worked there JUST for the health insurance.

VeggieGirl · 04-19-2008, 10:19 PM

I do need to work part-time. Right now I'm working with kids with autism, and the health insurance plan is only for those who work more than 30 hrs/wk. I'm trying to keep my hours under 20, so I can focus on school. I'll check into Starbucks and others...

I'm going to make an appt. to see my last provider at the school clinic. I'd like to see what they sent Humana, because the "possible insulin resistance" is news to me. I don't know if they're pulling that from the PCOS info, or if I mentioned my concern over it to my clinician and they took note of it, or if they actually saw something in my labs and neglected to tell me.

Ugh. I regret going there now, but I needed a Pap and different BCP, and I had my labs done for multiple reasons, including hair loss. I was so stressed about my hair loss and I just wanted help so bad...turns out they didn't even test anything for it, but it's probably in my chart, anyways.

01-04-2008, 04:31 PM	#1 (permalink)
VeggieGirl Vegan Cyster! Join Date: Oct 2003 Location: USA Posts: 82 Points: 4,944.79 Bank: 0.00 Total Points: 4,944.79 Donate	Insurance coverage! I have been treated for various symptoms of PCOS for years and it's been documented in my medical chart that I've been on Spiro for hirsutism, BCPs for hirsutism, etc. My old doctor never officially diagnosed me with PCOS because she said she thought it was "mild" and "temporary" and she didn't want me to have the diagnosis for insurance purposes (I wish I had gotten a 2nd opinion but I was young and naive!) Now, I currently do not have insurance but I'm a college student and I'm using the student health system. I really feel that I need to get treatment and I'm sick of not being formally diagnosed- I have facial and body hair, sporadic periods, acne, and now I'm starting to have noticeable hair loss that I want treated. I've looked into purchasing my own insurance (my part-time job doesn't offer it) but the ones I looked at don't cover "pre-existing conditions". I'm worried that since it's noted in my chart that there are PCOS concerns, they won't cover it if I do get a diagnosis. Or, if I use the student health system for treatment w/o getting a formal diagnosis, will it count as a "pre-existing condition" later on when I get insurance? I don't want to mess this up! __________________ 24 yrs old Currently taking Ortho Tri-Cyclen and Saw Palmetto Love your life!

01-04-2008, 04:50 PM	#2 (permalink)
KatCarney SoulCyster #1 Join Date: Nov 2000 Location: Los Angeles, CA Posts: 16,797 My Mood: MyEbay : Points: 1,166,411.95 Bank: 0.00 Total Points: 1,166,411.95 Donate	Your doctor did you a favor, since you currently don't have coverage. Unfortunately, in many cases, getting a 'formal' diagnosis won't improve your treatment in any measurable way. If it were me, get coverage before pushing anyone to diagnosis me 'on record'. A diagnosis, coupled with active treatment costs BEFORE coverage can frequently make it difficult to obtain coverage later. __________________ To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. COMING SOON - The New Soulcysters! - CLICK TO READ!! To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

01-04-2008, 05:08 PM	#3 (permalink)
VeggieGirl Vegan Cyster! Join Date: Oct 2003 Location: USA Posts: 82 Points: 4,944.79 Bank: 0.00 Total Points: 4,944.79 Donate	I had excellent insurance then, under my mother's plan. The doctor didn't think I had "real" PCOS because I'm not obese, and she said the facial hair would "go away" after I was finished with puberty. That's why she didn't diagnose me- the mildness of my symptoms (according to her) wouldn't be worth having the official diagnosis over. I'm worried about getting any more treatment on record before getting insurance, but I'm also worried about not getting treatment for years just b/c I don't have insurance. How long do you think I can continue to be treated "informally" before a future insurer will consider it a pre-existing condition? Or will they never consider it one if I'm never formally diagnosed? __________________ 24 yrs old Currently taking Ortho Tri-Cyclen and Saw Palmetto Love your life!

01-04-2008, 05:35 PM	#6 (permalink)
VeggieGirl Vegan Cyster! Join Date: Oct 2003 Location: USA Posts: 82 Points: 4,944.79 Bank: 0.00 Total Points: 4,944.79 Donate	Thanks for your input. I'm looking at some student plans that cost around $60/mo- they don't cover much, but they're something. I think I want the diagnosis for validation, more than anything else. But I know you're right...what I need to do is find a good doctor who knows about PCOS and stick with him/her. Thanks again __________________ 24 yrs old Currently taking Ortho Tri-Cyclen and Saw Palmetto Love your life!

01-04-2008, 06:54 PM	#8 (permalink)
bec415 Married to my best friend Join Date: May 2005 Location: VA Posts: 1,104 My Mood: Points: 78,189.94 Bank: 0.00 Total Points: 78,189.94 Donate	It's probably different in every state, but when I was in New Jersey I had to get my own indivdual coverage, I hadn't had insurance for a couple of years. So every time I went to see a doctor, got bloodwork etc. it went under a review process to decide if it was a pre-existing condition I was being treated for. What happened in the end, is I had to pay almost everything myself, even though I never had a formal dx for pcos, hadn't even seen a doctor in over two years, they determined I had been treated for a pre-existing condition??!! Anyway, be careful of this since you haven't had insurance for a while. If I were you, I would get the insurance if there is a pre-existing clause, wait a year before getting any huge tests done. See if you can get onto spiro to help with your hair loss, acne etc. But if you get any tests run be prepared to have to pay it out of pocket. __________________ To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts. Metformin 2000mg, Levothyroxine (synthroid) 50mcg, B12 & fish oil. 30 lb weight loss goal before ttc in December

04-19-2008, 08:49 PM	#9 (permalink)
VeggieGirl Vegan Cyster! Join Date: Oct 2003 Location: USA Posts: 82 Points: 4,944.79 Bank: 0.00 Total Points: 4,944.79 Donate	I applied with HumanaOne for their "emergency coverage only" plan, and they denied me due to "possible Polycystic Ovarian Disease" and "possible insulin resistance". They apparently got that information from my college health clinic, where I recently had a Pap and some labs done to check my vitamin levels, cholesterol, etc. This is very bad, I think. __________________ 24 yrs old Currently taking Ortho Tri-Cyclen and Saw Palmetto Love your life!

04-19-2008, 10:19 PM	#11 (permalink)
VeggieGirl Vegan Cyster! Join Date: Oct 2003 Location: USA Posts: 82 Points: 4,944.79 Bank: 0.00 Total Points: 4,944.79 Donate	I do need to work part-time. Right now I'm working with kids with autism, and the health insurance plan is only for those who work more than 30 hrs/wk. I'm trying to keep my hours under 20, so I can focus on school. I'll check into Starbucks and others... I'm going to make an appt. to see my last provider at the school clinic. I'd like to see what they sent Humana, because the "possible insulin resistance" is news to me. I don't know if they're pulling that from the PCOS info, or if I mentioned my concern over it to my clinician and they took note of it, or if they actually saw something in my labs and neglected to tell me. Ugh. I regret going there now, but I needed a Pap and different BCP, and I had my labs done for multiple reasons, including hair loss. I was so stressed about my hair loss and I just wanted help so bad...turns out they didn't even test anything for it, but it's probably in my chart, anyways. __________________ 24 yrs old Currently taking Ortho Tri-Cyclen and Saw Palmetto Love your life!

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