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Old 05-30-2012, 05:29 PM   #1
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Join Date: Apr 2012
Location: Washington, DC
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harperb HB User
Questions about waiting period

I've been having a number of health problems over the last 5 months. Though I had several tests, the only thing they found was one small ovarian cyst and my gyn put me back on the birth control pill. I was also having GI issues, but a visit to the ER turned up no diagnosis. I was unemployed/uninsured at the time I got these tests run. I'm self-employed now and just got approved for an individual plan, but they considered the ovarian cyst a pre-existing condition and now I have a 10-month waiting period on ovarian cysts and "disorders of the menstrual cycle" which is vague enough to encapsulate virtually everything gynecological. Needless to say, I'm not a happy camper, particularly since my symptoms are worsening.

So, my coverage starts 6/1 and I'm having back pain and GI pain (in addition to pelvic pain). I think the back and intestinal issues are related to the GYN issues; however, I can't wait 10 months to go see a GYN and have them assessed. So, I have 2 questions (I would ask the insurance provider, but I can't very well go fishing for ways to get around their waiting period!):

1) I'm thinking of going to a general practitioner (rather than a GYN) and having him run tests to look at my GI and back symptoms. If the tests turn up a diagnosis that is GYN-related, is the insurance company likely to deny coverage since the underlying problem is related to "disorders of the menstrual cycle"?

2) If I go to a GP during the first week of my coverage complaining about symptoms that started months prior to my insurance application (and were documented by my ER visit), is the insurance company likely to deny coverage?

3) If I have to go to a GYN, I'm assuming I have to pay all of it out of pocket. If I get diagnosed with something else (say, endometriosis, fibroids, etc.) during the waiting period, is this considered a new pre-existing condition, subject to another waiting period? Will it affect my ability to get coverage once the 10 months are up? I'm trying to figure out whether I need to avoid getting diagnosed during the next 10 months.

I know nobody can tell me the answers to these questions without knowing my insurance plan/provider/state, but if anyone has experience trying to navigate a waiting period I would appreciate the feedback. I've been fortunate to never have a pre-existing condition before, so this is all new to me.

Thanks.

 
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