Is untreated/undiagnosed SA considered preexisting condition

[cake321]

I have searched around, but was unable to find someone in the exact situation that I am in. Based on everything I have read online, I am convinced that I have sleep apnea. I have all of the symptoms. I have NOT been treated, or diagnosed for sleep apnea. I have never gone to a doctor about this issue. I will be getting health insurance next month, and have not had health insurance for about 2 years (so there is a gap). I plan to see a sleep doctor once I am enrolled. Could my insurance claims be denied, with sleep apnea being considered a pre-existing condition? I live in the state of Louisiana, if that helps. Again, I've NEVER been to a doctor about it before this.

Thanks in advance for any replies.

[Alshain]

It isn't a pre-existing condition unless you have been diagnosed. OSA can be developed over time, just because you have it doesn't mean you had it before and there is no way an insurance company would know you even suspected it unless you told them. Hint: Don't tell them.

[cake321]

It actually wasn't even listed as one of the conditions/questions on the paperwork I had to fill out prior to enrolling.

[Alshain]

Pre-existing condition clauses don't cover ongoing medical treatment anyway. If a person that requires oxygen switches insurance companies, the new insurance is still going to pay for the oxygen & equipment because it's a life long medical treatment. CPAP is no different.

I wouldn't worry about it.

[Pugsy]

If there is no documentation anywhere about your symptoms then there is not much chance for insurance underwriters to discover anything. If they knew about it they would surely deny coverage or at best exclude it.

Is the coming insurance a group policy or individual policy?

If it were me and I was young enough that having sleep apnea history could be a problem for years to come with insurance, I would probably self treat and never tell a soul. While it isn't fair that sleep apnea effectively treated will put a huge red flag on your history, the fact is that it will.

[avi123]

I have searched around, but was unable to find someone in the exact situation that I am in. Based on everything I have read online, I am convinced that I have sleep apnea. I have all of the symptoms. I have NOT been treated, or diagnosed for sleep apnea. I have never gone to a doctor about this issue. I will be getting health insurance next month, and have not had health insurance for about 2 years (so there is a gap). I plan to see a sleep doctor once I am enrolled. Could my insurance claims be denied, with sleep apnea being considered a pre-existing condition? I live in the state of Louisiana, if that helps. Again, I've NEVER been to a doctor about it before this.

Thanks in advance for any replies.

IMO, an insurance company can deny you insurance for pre-existing conditions regardless if you know or knew about it.


"Many Americans have health-related problems that insurance companies define as pre existing conditions. A pre-existing condition is a health problem that existed before you apply for a health insurance policy or enroll in a new health plan."


See also:

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

[cake321]

If there is no documentation anywhere about your symptoms then there is not much chance for insurance underwriters to discover anything. If they knew about it they would surely deny coverage or at best exclude it.

Is the coming insurance a group policy or individual policy?

If it were me and I was young enough that having sleep apnea history could be a problem for years to come with insurance, I would probably self treat and never tell a soul. While it isn't fair that sleep apnea effectively treated will put a huge red flag on your history, the fact is that it will.

It's an individual policy

[Uncle_Bob]

Just a word of advice. if you are considering purchasing term life insurance, purchase it before you get diagnosed with OSA.

[cake321]

I have searched around, but was unable to find someone in the exact situation that I am in. Based on everything I have read online, I am convinced that I have sleep apnea. I have all of the symptoms. I have NOT been treated, or diagnosed for sleep apnea. I have never gone to a doctor about this issue. I will be getting health insurance next month, and have not had health insurance for about 2 years (so there is a gap). I plan to see a sleep doctor once I am enrolled. Could my insurance claims be denied, with sleep apnea being considered a pre-existing condition? I live in the state of Louisiana, if that helps. Again, I've NEVER been to a doctor about it before this.

Thanks in advance for any replies.

IMO, an insurance company can deny you insurance for pre-existing conditions regardless if you know or knew about it.


"Many Americans have health-related problems that insurance companies define as pre existing conditions. A pre-existing condition is a health problem that existed before you apply for a health insurance policy or enroll in a new health plan."


See also:

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

But, how could something like this be enforced, with me having no documented medical history of sleep apnea? How could an insurance company determine when the conditions arose?

[BlackSpinner]

But, how could something like this be enforced, with me having no documented medical history of sleep apnea? How could an insurance company determine when the conditions arose?

Because they try. Because they are it for the money not for your health. If they could get away with it they would define all young women as pre-pregnant and deny all coverage for pregnancy related issues.

[cake321]

Also, just to clarify, I have already been approved for the actual insurance policy (will start in 2 weeks). My concern is that once I go to a sleep doctor, they will refuse to pay my claim. Not sure how much that matters...

Thanks again, guys.

[Pugsy]

Individual policies have stricter underwriting.

When you go to doctor about the sleep apnea symptoms it may put a red flag out. I saw a knee surgery get denied because in the history the patient told the doctor that he had been having problems off and on for 10 years. No injury.
Insurance denied it because he didn't mention the knee pain on the application even though he never saw a doctor for it.

[goldfinch]

Here I was never going to go on this forum again after I was told by a poster that my career should be illegal (I was a lobbyist on consumer health care matters). Oh well, there is no sin in changing one's mind. And I saw your post and I see misinformation from several posters.

You have not been treated or diagnosed with sleep apnea so it is not going to turn up in most underwriting. Answer the questions honestly on the application. Odds are there are no questions about undiagnosed symptoms. However, there is some question about the extent insurance companies do post claim underwiting to see if they can find a reason to cancel a policy. The extent of this activity is unclear.

For example, if you make a claim within some months of getting a policy the insurer may go back and review the information it gathered when issuing the policy. Will it go so far as to say that your symptoms must have been such that a reasonable and prudent person would have obtained a diagnosis of sleep apnea? And thus it should have been disclosed? It is possible but I can't estimate the likelihood. And the next issue is whether it is breach of contract or illegal for them to cancel for that reason. Here is a paper on post-claim underwriting: http://www.rwjf.org/files/research/6120 ... riting.pdf

To see what your rights are in a particular state I suggest this Georgetown University site: http://www.healthinsuranceinfo.net.

[cake321]

Hmm, so much conflicting information! I guess my best plan is to not mention that I felt any symptoms prior to the effective date.

[cake321]

Does anyone have any actual experiences they can share? I'm beginning to panic about this. I really can't deal with sleep apnea anymore, but theres no way I could afford treatment if they deny me.