[sunrise]

I will be needing to find a new health insurance provider in a few months and have started looking around. I found a questionnaire used in my state by many insurers to assess a person's health and help determine if the insurer will insure them. If the person scores 325 pts or more on the questionnaire (each health condition they have is assigned a certain number of points), they will most likely be rejected by the insurer.

I was curious to look at the points for all of the ailments I have, e.g. hypertension. It was interesting to look at mental disorders. For having the mental disorders below diagnosed at any time during the last 5 years, these are the points you get:

204 pts - Mood disorder - bipolar (e.g. cyclothymic disorder)
70 pts - Mood disorder - depression (e.g. dysthymia)
210 pts - Opioid or barbituate dependence
235 pts - Psychotic and schizophrenic disorders
32 pts - Other mental health conditions (e.g. adjustment disorders, ADHD, anxiety disorders, eating disorders, PTSD, panic disorder, phobias, seasonal affective disorder)
44 pts - Other substance abuse conditions (e.g. dependence on alcohol, cocaine, amphetamines, cannabis)

I am near the 325 point cutoff so a psych diagnosis could make a difference. I am going to check with my PNP next time I see her. She has never come right out and said, "you have such and such," but she has said I have "ADHD-like symptoms" and she prescribes for me accordingly. Maybe she is very careful not to say "you have ADHD" for reasons like this--that it could haunt me later when trying to get insurance. I have never prodded her for an official diagnosis, as I haven't seen how it would help me. (I don't like being labeled.) Plus, she can prescribe for my symptoms without making a diagnosis. One thing I worry about is that on one of my insurances in the past, I could see on their forms that she had given the reason for my visit as "MDD, recurrent." Now she's never said to me that I have MDD, and that is not the reason I go to her, but I know that providers often put in a different diagnosis to insurance than what you actually have so that they can get reimbursed more easily. So I hope that this won't count against me. ADHD is only 32 points and MDD would be 70, which would put me over the 325 limit.

I am going to start being more proactive with my doctors when I see them in the next few months and make sure the correct diagnoses are in my chart and that outdated or inaccurate ones are corrected. If there is no diagnosis in the chart, that is the best (for this purpose).

[Perna]

I would think they could ask/find out what medicines you have been prescribed in a certain period of time and do something with that too. I was turned down for health insurance because I'm obese. My state has guaranteed insurance though so I bought the State insurance, which is the exact same Blue Cross/Blue Shield, probably a bit more/less expensive, who knows. I'm retired but too young for Medicare so have that gap.

[sunrise]

Hi Perna, thanks for responding. My state also has a pool for the "uninsurable." So maybe I could get that if I fail. They've cut back a lot on who they offer insurance to, though, and there may also be other hoops to jump through to qualify.

The meds thing is another reason I'm worried, as one of the two I take for ADHD is Wellbutrin, which is also prescribed for some people as an antidepressant. So a bean counter could look at my prescriptions, not know any better, and say, "she's taking Wellbutrin, so she must be depressed."

The whole thing makes me glad at least that my therapist has never been reimbursed by my insurance, so at least that's one less mental health thing to be on my record. (He's never given me a diagnosis so I don't have to report anything from him.)

[Eliza Jane]

I had to buy insurance on my own and ran into a lot of problems. When I first applied, I was told that I was automatically disqualified because I was taking abilify (for MDD) and that is a drug that "indicates serious psychiatric problems." If I had been taking a different drug, that would have been a problem too---if you are on more than 2 drugs, you are disqualified.

The second time I applied, I did not indicate that I was taking abilify, but I was honest about the fact that I was in therapy. Guess what---therapy automatically disqualified me becaue it indicates a "an active psychological problem."

Insurance companies are ruthless. Not having a diagnosis might not save you from being disqualified.

On the bright side, I was able to get insurance through my state's high risk pool. It is decent insurance.

Best,
EJ

[sunrise]

Thanks, Eliza Jane. I think you are right about how they are ruthless. I will just hope for the best.

Luckily there is no evidence in any record anywhere that I am in therapy, and they don't ask about that on the questionnaire.

That is good to hear that the state insurance you got is decent.

[sittingatwatersedge]

(((((((((((( Sunny )))))))))))
I had started a new thread on a private forum but it has disappeared...

Your concern is very valid (about someone's arbitrary interpretation maybe causing a problem for you).
I know someone who was dx'd with restless leg syndrome and it was easilly controlled with a simple med - that was the good news - the bad news is that that med is also used in treatment of epilepsy (not at all an issue for this person) and the FAA won't let him fly any more. No appeal.

I so wish I had some good ideas to give you, I have only these I hope that's OK

[crazycanbegood]

Originally Posted by sittingatwatersedge

(((((((((((( Sunny )))))))))))
I had started a new thread on a private forum but it has disappeared...

Your concern is very valid (about someone's arbitrary interpretation maybe causing a problem for you).
I know someone who was dx'd with restless leg syndrome and it was easilly controlled with a simple med - that was the good news - the bad news is that that med is also used in treatment of epilepsy (not at all an issue for this person) and the FAA won't let him fly any more. No appeal.

I so wish I had some good ideas to give you, I have only these I hope that's OK

won't let him fly anymore?? sit on the plan or drive the plane?

[sittingatwatersedge]

Originally Posted by crazycanbegood

won't let him fly anymore?? sit on the plan or drive the plane?

drive the plane. sorry

[sunrise]

Originally Posted by sittingatwatersedge

I know someone who was dx'd with restless leg syndrome and it was easilly controlled with a simple med - that was the good news - the bad news is that that med is also used in treatment of epilepsy (not at all an issue for this person) and the FAA won't let him fly any more. No appeal.

Yep, that's the sort of thing I'm concerned about. Yesterday I went to see my doctor about some trouble I'm having sleeping at night. He told me that women my age often have trouble sleeping due to declining hormones, and he suggested I take an SSRI. He said serotonin would help me sleep. I feel like I need another psych med like I need a hole in the head. And the insurance is bound to look at that and think I am taking it for depression.

[sittingatwatersedge]

hi Sunny,
how did this turn out for you? you OK?

[sunrise]

Thanks for asking, SAWE, I'm doing OK. I was not prescribed an SSRI for the sleep problem but may try ambien. We'll see. I did discontinue the Wellbutrin I was taking for ADHD and am now taking just one med for that. In general, I would like to take fewer meds of all types but if the Ambien helps me sleep longer at night, it might be worth it.

[skeksi]

I hope you find something to help you sleep well, sunrise.

Your original post really rings true for me. I needed therapy as soon as I let home and I knew it, but I felt like I couldn't get it. First because I was in college and couldn't have my parents know about it (what happened at home is why I *needed* therapy!); then because I was in a series of jobs that I knew were temporary. I had heard about being refused coverage for preexisting conditions, so I didn't want whatever it was I had to be diagnosed until I was in a solid, long-term position.

I think it's sad that we have to worry about having insurance coverage when we decide to seek help. It's not what the system should be.

[CantExplain]

Originally Posted by sunrise

For having the mental disorders below diagnosed at any time during the last 5 years, these are the points you get:

204 pts - Mood disorder - bipolar (e.g. cyclothymic disorder)
70 pts - Mood disorder - depression (e.g. dysthymia)
210 pts - Opioid or barbituate dependence
235 pts - Psychotic and schizophrenic disorders
32 pts - Other mental health conditions (e.g. adjustment disorders, ADHD, anxiety disorders, eating disorders, PTSD, panic disorder, phobias, seasonal affective disorder)
44 pts - Other substance abuse conditions (e.g. dependence on alcohol, cocaine, amphetamines, cannabis)

Bipolar is four times as bad as cocaine addiction?!

Unbelievable.

[bluemountains]

Hi sunrise,
The pdocs that my son and I see have warned us about labels and how these can affect future insurance. They are especially concerned with labeling a child who grows and changes. We are both treated for mental disorders (I guess the 32 pt. kind) although we have been told we both are treated within the bipolar spectrum.
At first, I found this change of diagnosis confusing, but it appears that our docs are trying to stay ahead of the insurance game.
Bluemountains