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chynabear · July 2005

I met with my new oncologist two days ago for my first post-chemo visit and they ran some blood work which all came back fine. I am scheduled to have a PET/CT on the 28th and then every 3 months after.

He also mentioned talking to a genetics counselor and doing testing. I can definitely see the benefits of doing this but I have heard that if the test does come back to show that there is something genetic (0 family history) then insurance can deny all claims bec it is a pre-existing condition.

Here are my thoughts: I have great insurance and they have been great so far. They could have already denied the claims on pre-existing clause bec according to my oncologist I have probably had cancer on the side of 5+ years now.

Any ideas or concerns? Has anyone else had these tests done?

2bhealed · July 2005

hi chyna,

I decided against the testing. I did not want something like this to come back and haunt my family. What was the point? My kids know that they will have to be fervent in their health--colonscopies are a reality of their future regardless what the genetic tests say.

Now, having said that I am part of a study of colon cancer in families through the Mayo Clinic. But this is different. Nothing goes on my record.

I had zero family history too before my sister died of adenocarcinoma of the small intestine and then I got same in my sigmoid. go figure. She was 33 when she died and the docs say that my tumor was probably in me for 10 years which puts me in my late 20's early 30's when it started. (same time as when my sister died).

peace, emily

Betsydoglover · July 2005

Hi -

I think you may be over-interpreting the meaning of pre-existing conditions. First I have to say that I am NOT a lawyer. But, I did a little research and what I found is pretty much as follows (found this info in several places):

Under the HIPAA law, no insurance company can define pre-existing condition any more restrictively than what HIPAA allows. So, your insurance cannot use this clause in any way not allowed by the law.

The law seems to pretty much say the following:
a) pre-existing condition limitations cannot last longer than 12-18 months depending upon when you enrolled, so if you have had your insurance longer than that, it is not something you need to worry about.
b) A preexisting condition limitation, under HIPAA, may be imposed only for medical conditions for which medical advice, diagnosis, care or treatment was recommended or received within the six month period ending on your date of enrollment in the health plan.

There are other factors which can reduce the limitation to less than 12-18 months, but the bottom line seems to be that even if a condition was pre-existing by your definition, it can only legally be considered that way if some medical advice or treatment was received within 6 months prior to your enrollment. So, if you just got your insurance last month and are newly diagnosed with a condition which had not previously sent you to the doctor, then that condition is not considered pre-existing. And, even if you have a pre-existing condition, it does not matter after 12-18 months.

I hope this helps. And as I said, however, I am NOT a lawyer.

Meanwhile, good luck with your scans and decision about the tests.

ramona41 · July 2005

Hi chyna I decided not to do the genetic thing. My sons know they have to be tested as do my siblings. as far as the pre-existing condition..doesnt the condition need to be known?? to exist? my doctor said my tumor probably had been growing 5 to 10 years..how the heck should I have known?? do what you feel is right.. thats what matters.. peace..ramona41

kerry · July 2005

Betsydoglover said:
Hi -

I think you may be over-interpreting the meaning of pre-existing conditions. First I have to say that I am NOT a lawyer. But, I did a little research and what I found is pretty much as follows (found this info in several places):

Under the HIPAA law, no insurance company can define pre-existing condition any more restrictively than what HIPAA allows. So, your insurance cannot use this clause in any way not allowed by the law.

The law seems to pretty much say the following:
a) pre-existing condition limitations cannot last longer than 12-18 months depending upon when you enrolled, so if you have had your insurance longer than that, it is not something you need to worry about.
b) A preexisting condition limitation, under HIPAA, may be imposed only for medical conditions for which medical advice, diagnosis, care or treatment was recommended or received within the six month period ending on your date of enrollment in the health plan.

There are other factors which can reduce the limitation to less than 12-18 months, but the bottom line seems to be that even if a condition was pre-existing by your definition, it can only legally be considered that way if some medical advice or treatment was received within 6 months prior to your enrollment. So, if you just got your insurance last month and are newly diagnosed with a condition which had not previously sent you to the doctor, then that condition is not considered pre-existing. And, even if you have a pre-existing condition, it does not matter after 12-18 months.

I hope this helps. And as I said, however, I am NOT a lawyer.

Meanwhile, good luck with your scans and decision about the tests.

Betsy,

Great advice!!

Kerry

kerry · July 2005

Betsydoglover said:
Hi -

I think you may be over-interpreting the meaning of pre-existing conditions. First I have to say that I am NOT a lawyer. But, I did a little research and what I found is pretty much as follows (found this info in several places):

Under the HIPAA law, no insurance company can define pre-existing condition any more restrictively than what HIPAA allows. So, your insurance cannot use this clause in any way not allowed by the law.

The law seems to pretty much say the following:
a) pre-existing condition limitations cannot last longer than 12-18 months depending upon when you enrolled, so if you have had your insurance longer than that, it is not something you need to worry about.
b) A preexisting condition limitation, under HIPAA, may be imposed only for medical conditions for which medical advice, diagnosis, care or treatment was recommended or received within the six month period ending on your date of enrollment in the health plan.

There are other factors which can reduce the limitation to less than 12-18 months, but the bottom line seems to be that even if a condition was pre-existing by your definition, it can only legally be considered that way if some medical advice or treatment was received within 6 months prior to your enrollment. So, if you just got your insurance last month and are newly diagnosed with a condition which had not previously sent you to the doctor, then that condition is not considered pre-existing. And, even if you have a pre-existing condition, it does not matter after 12-18 months.

I hope this helps. And as I said, however, I am NOT a lawyer.

Meanwhile, good luck with your scans and decision about the tests.

Betsy,

Great advice!

Kerry

rejoyous · July 2005

I was too much in shock and overwhelm to follow up on the testing advice I received when initially diagnosed a year ago. I did go for counseling and they told me there was no rush, so I decided to take my time.

Now I'm thinking I'll probably do it, if I can get my insurance company to pay for it. (It's expensive.) I don't fit the exact criteria for the known genetic conditions, but on the other hand, there are definitely some weird cancer constellations in my generation of my family.

I'm thinking that testing may open the door to some new insights that might help my kids, m y cousins' kids, or perhaps others outside my family. The research on all this is so new and moving so quickly. If getting a good look at my tumor will contribute anything to anyone's knowledge base, I'd be glad.

--Ellie

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