Diagnosis Causes Insurance Discrimination?

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On several occasions, it has been mentioned that diagnosis can lead to discrimination by one's insurance company, at least in the US, where I live. Does anyone have any experience with this or further knowledge on the subject? What does the discrimination involve? Do they deny coverage? Or start charging more $$$? Does anyone know if this varies based on what type of treatment (or lack thereof) you seek? Are some companies known offenders?

I'm curious because I have an appointment to see about a diagnosis next week. My psychiatrist does not take insurance, so I doubt the company would find out. Secondly, I'm insured through my school, so they charge the same rate for everyone and no one gets turned away. However, it would be good to know in case I get refered to another doctor who does take my insurance.

I don't have the answer, but if Michael Moore accurately displayed the realities in the USA in his more recent film Sicko...I can't even begin to imagine the hell one must feel dealing with medical insurance over there. I was near physically ill no more than 20 minutes into that film...

I hope for your sake, it is not true.

I wouldn't doubt it. Insurance companies have become awful. There's actually no record of my diagnosis. My mother yanked me out of the office we went to because she was insulted by the diagnosis I got. I'd like another opinion (I'm sure I have it, but want the confirmation now as an adult from a second party) but I want to do so anonymously. I haven't figured out how. I don't want a paper trail.

another country? pay for it elsewhere!

That sounds reasonable. Maybe you could refrain from using insurance, pay in cash, and give a false name? Most of the psychiatrists I've been to don't take insurance. In my experience, they try to make the diagnosis in the first session, which usually costs $100 - $150 and lasts at least an hour. They only ask for your contact info so they can track you down if you don't pay, so if you paid in cash right away, I don't see why they would care, or how they would find out.

Yes, indeed, try being uninsured; that's been my reality for the past 14 months. You might as well be a nothing to the medical community if you're uninsured. That is, if you can even find a doctor/hospital/clinic who will take you without insurance or a big fad wad of cash upfront; and good luck with that, as they almost don't exist. In this country, your moral worth and the worth of your life is determined by how much money you have, at least as far as health care is concerned.

I will only become insured 30 days after my wedding on Nov. 23, when I'll be eligible for coverage through my new husband's policy. And then I'm sure they'll find all kinds of ways to deny coverage of all kinds of things, especially since I'm in my early forties. God help me if I get a major illness or have a major accident/injury before I'm covered, because then it'll all be over for me financially. That's why I've put off my yearly mammogram that I was supposed to have had back in March. I could have paid for the mammogram itself. The problem is, on the very off chance that it discovered any cancer, I would not have been covered even if I subsequently because insured due to their bleeping @#$%#^#$Q pre-existing condition nonsense.

And it'll never change as along as Congress has the health insurance program it does; it covers EVERYTHING, no matter what, for about $35 a month, an extremely low deductible (usually $250), and full prescription coverage. Paid for courtesy of the very taxpayers like me who do NOT have insurance and, even when we do, will never have that kind of coverage. Egads, don't even get me started on this, we'll be here all night.

As far as the OP's question. Yes, absolutely, they can, will and do discriminate based on such diagnoses and not just AS, either, oh, no, far from it. They will even discriminate if you have a family history of a particular disease, or if your genetic profile shows you have a possibility of getting a particular disease, even if you do NOT currently have it and show no signs. And, in order to deny as many claims as possible and, thus, increase and maximize profit, they will comb through insurance applications to find any excuse whatsoever to deny you coverage. It can be something as trivial as forgetting to mention that you had the sniffles on a particular date, doesn't matter, they WILL find something. For-profit health care is one of the most sickening aspects of this society. Period.

When the insurance salesman came to my house for the health insurance. I took a look through the underwriters manual. A diagnosis of Autism was one of those ailments for being excluded from any of their insurance coverage they were selling. No major medical, no life insurance. I simply kept my mouth shut about me being diagnosed on the Autism Spectrum for almost all of my life. I don't have the luxury of fighting the insurance company and their lawyers in court. Believe me my life has been hard enough already.

I can get on with my life just like anyone else though admittedly I will always be a little different. Am I asking for this and that therapy or specialist and have the insurance company have to pay tens or hundreds of thousands of dollars?

That is basically what the insurance company is afraid of

No. I am asking that if I break my leg or have appendicitis I will simply be covered like everyone else and won't end up on welfare or bankruptcy for the rest of my life from a hospital bill that I could never pay off. I don't know how it is with other insurance polices but this is how it was with mine. Moral of my rant: Keep it off your medical record and keep your mouth shut with the insurance salesman.

YOU COULD SAVE A BUNCH OF FIVERS, ASPIES ARE THE SAFEST DRIVERS. FOR THE CHEAPEST ENSURANCE DEAL BLOKES GET ON TO ASPIE WHEELS. ! !! !! !! !!

We are more careful then male NT men and more skilled then NT woman.

OHHhh you was talking about medical insurance. In the UK we have NHS.

Yes, it is true. I'm not sure if it is based on the area or not in the US, but it is very true. I cannot get medical insurance, and have had MEDICAID taken from me before of all things! They do not recognize it as being something that will prevent me from having other insurance, and the other places will deny quickly-I'm still unsure why... I'm lucky to have my medicaid, but I go for 3 month stretches from time to time in which they just deny me repeatedly until I fill out enough applications over and over that it finally goes through (referring to medicaid).

Hi, Everybody;

I bolded the important things since the post turned out longer than my usual ones do and I didn't want you to have to plow through it all if you don't have the time.

I went without insurance for about a year due to my losing a job. I ended up in the hospital - not taking my blood pressure meds led to my getting congestive heart failure. While in the hospital (I was so sick I didn't care if I went bankrupt from the hospital bills so I went in) I was put on Freecare, which a social worker at the hospital set up for me. (If you go this route and they ask if you want to see a specialist for whatever is going on with you, that means it isn't covered by the Freecare-anything they can't do unless you consent to bring in another Dr/do tests, that means it isn't covered. Freecare covered the hospital room and the main Dr I saw there, and tests done in thhe hospital, but not tests someone from an outside Co. came in to do.) It turned out there was a clinic in the next town over from me. the social worker sent me there, and I got Freecare from them too, so I got a regular Dr, Prescription coverage, and hospital coverage from the hospital I originally went to.

Now my state (MA) has required coverage and a program to help people who don't qualify for Medicaid pay for it, so things are sill OK on the insurance front, although no longer free.

So, if you don't have insurance and are in the US, I would call a hospital and ask to talk to social services there. They will probably talk to you even if you are not an inpatient, since you might get hit by a bus tomorrow and need them to set up Freecare anyway. (And, really, do it - I wouldn't have a permanent heart problem if I had known Freecare was available to pay for my prescriptions.)

Oh, money - originally I made too much for completely free care, so I was supposed to pay a reduced rate for things. Sometimes the Drs wouldn't charge it, though. It was not a lot of money or I wouldn't have been able to afford it. Then I got poor enough that I qualified for the help for free.



KaliMa

I saw SiCKO. Excellent film. Anyway, as a former American, the premises of the film are correct. The Canadian health system isn't perfect, but it's pretty darn good!

Anyway, if you remember when they listed the "pre-existing conditions" with the Star Wars motif, Asperger's Syndrome is clearly listed as a criteria for refusing coverage.

It really doesn't make logical sense, however. Aspies in general tend to be very risk adverse. As such, we are more likely to perform acts of stupidity that NT's have a penchant for and thus require less emergency care. Oh well, I guess.

I have wondered if someone could file a lawsuit with the EEOC against a particular insurance company for doing this kind of thing if it is seen as violating the Americans With Disabilities Act.

I have wondered about that as well. But all they would have to do is rebut it by saying that there are other companies who do offer coverage for those with autism, lol. At least, I assume this is why people don't. There are a lot of people who have tried, I believe, but it never goes through. I always wonder though, if there are some that do accept it, why do they not at least give a list that will accept those with the problems that their company will not accept. I've seen some of the lists of things that insurance companies will not accept, and it's amazing how much they won't do... and it's also amazing how many are accepted, but denied care due to the cost, or the company deciding that it is not a procedure that is needed.

I saw SICKO as well, and that list reflected pretty well what I've managed to find out. I don't doubt one bit that anybody has died due to a last minute denial claiming that something does not NEED to be done. I just wonder how the heck they are able to cover it so well when it happens...

I don't know. I'm certain that Capital Health Plan specifically excludes treatment for autism and autism related conditions. My personal concern is that "autism related conditions" could be so broadly intrepreted as to exclude treatment for depression, for example.

Capital Health Plan is owned by Blue Cross/Blue Shield. I once had to file a complaint against BC/BS with the state insurance commissioner because they refused to pay for a minor outpatient surgical procedure. BC/BS finally came up with $50 for my $750 procedure.

Asperger's was specifically mentioned in Sicko?!? Oh great.

So...what the heck? I've got an appointment set up for next month, which apparently my insurance IS covering (apparently it takes all day and would normally cost several hundred dollars).

I really want to find out, both for myself, and so that theoretically I could get help (except no such help probably actually exists). But...I wonder if technically I shouldn't do it.

I've got BC/BS too. It's really expensive and they don't cover much of anything. Plus they're always changing their phone number, so my claim gets denied, then I have to call the doctor's office, give them the right phone number, and convince them to rebill the company. Then it turns out that only 20% of the cost is covered. They won't even allow me to get an annual physical because they say it's unnecessary.

I think it would be cheaper for me not to have insurance, but my parents are afraid that they'll somehow get stuck with a huge bill if I don't and something horrible happens to me. So I keep paying for it, out of my student loan.