Medical insurance question

[Manonash]

Not sure if this is the right place for this, so I'm cross-posting in Health and Healing.

I'm wanting to get some lab tests done and it may be hard finding a doctor who will order them. If I order them on myself, will that make it so that our insurance company can deny me coverage for the condition it tested for if I'm positive for the condition I'm testing for?

Thanks!
Shonda

[doctormom]

If you don't want the insurance company to have access to your results (because they may deny you care, or may count it as a "pre-existing" condition in the future) then you may want to pay for those tests yourself, out of pocket. If you go through the insurance, they will obviously have a record of what testing you had done.

It's hard to advise you any more specifically without knowing what condition you're talking about - some are "red flagged" more often by insurance companies. For example, hypothyroidism would be less of a big deal than multiple sclerosis, because of significant differences in cost of care. If you have access to a doctor you trust, you may want to discuss it confidentially with that person before making a decision.

[whateverdidiwants]

Do you already have coverage? Are you in a pre-existing window?

If you already have established coverage, most likely they will pay for your treatments or medication, but they will not pay for the labwork you had done on your own.

Out of curiosity, how are planning to order your own lab tests? I've never heard of a lab that would run tests without an order form from a doctor.

[Manonash]

I suspect I may have histadelia after looking up information of OCD and causation. I really fit a lot of the characteristics and physiology. The thing is, it can be kinda tricky because there is cross-over with symptoms from histapenia (the opposite condition). There are some tests that conventional docs don't order very often that you can sometimes have done by ordering them on yourself from independent labs. For example, I did some intracellular chemistry tests on myself thru Spectracell (very informative by the way). I'm not sure about the tests I want to do whether or not they can be ordered independently or not, but will be checking on that soon.

I do have existing coverage now. My concern was that it would go the way I've heard some genetic testing has gone. Ex. A person wants to be tested for a breast cancer gene, and tests positive. I've heard that if she gets a positive test result, then the insurance can deny her coverage if she gets it because they can call it pre-existing, even though there wasn't a lapse in coverage. I have no idea if that is true. Insurance issues make my head swim.

[USAmma]

I believe that if you don't know you have it and you get tested + for it, it is not a pre-existing condition. My dad has an inherited liver condition that took a long time to dx. Even though he's had it for his whole life, he was not denied coverage because they only just learned about it.

If you have a large group insurance usually they will not deny you for pre-existing conditions. It's one of the reasons my dh works for the stage gov't, because of my dd's health issues.

[SleeplessMommy]

From reading the wiki page, it sounds like this is in the "alternative medicine" category... so even if you "test positive" they won't cover treatment anyway.

For other things (HIV, blood sugar h1ac, genetic testing, etc) you could find a Dr or lab outside of the USA... there are some Internet docs that will order any test for you.

[polyhymnia]

I went to a doctor not covered by my insurance once for a routine checkup/bloodwork. I did so knowingly because I liked her a lot and was willing to pay rather than change doctors (again.). Unfortunately that was the time my thyroid went screwy, so I ended up being dx with hypothyroidism and needing medication, treatment, etc. My insurance would not pay for medicine prescribed by THAT doctor, but they paid for me to go see one of their doctors, have more bloodwork done, and then they paid for that script. So it was not treated as a pre-existing condition even though it was dx by someone not covered by my ins. co.