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Insurance question about preexisting conditions

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  • Insurance question about preexisting conditions

    Hi, I have a question that would probably be helpful for other people as well if anyone can answer it.

    In the HIPPA definition of a preexisting condition, do regular oncology checkups - surveillance (physical, chest x ray, and blood work) - constitute medical advice or diagnosis?

    I was diagnosed with TC in the past and did not have insurance. I paid for my treatment out of pocket. It has been more than 5 years since I finished chemo as of one month ago. Since then I have had frequent followup checkups. At no time since diagnosis in 2000 have I gone more than 6 months without some kind of checkup for surveillance. I would like to buy a high deductible (individual) health insurance policy now but I am not clear if TC would be excluded from coverage since my last checkup was less than 6 months ago.

    The HIPPA definition of a preexisting condition follows.

    A preexisting condition exclusion is limited to a physical or mental condition for which medical advice, diagnosis, care, or treatment was recommended or received within the 6 month period ending on the enrollment date in a plan or policy.

  • #2
    It all could depend on the policy wording. The best bet is to get a copy of the policy, review it and submit you question in writing and ask for a response in writing so you have it for your records. If you haven't carried coverage or it lasped you could be excluded for 6 months or longer for the TC or any preexisting condition that you had treatment for. remember that treatment can be just going to doctor it doesn't have to be xrays, lab work or surgery so to answer your question yes a follow up is medical advice since you wouldn't be going there if not for the TC, but that is my opinion and I would bet it would be their stand to get out of paying the bill. You would have to fight them they might bend you never know.
    Good Luck
    5-1-2006 Right IO - Stage 1 Nonseminoma Embryonal and Yolk sac - Surveillance Baby on the way Born 7-20-07