Would it be a pre-existing condition if you felt pain in your knee THEN got insurance before going to MD?

Question

Please help! I had knee pain and didn't have health insurance. I waited for a few weeks and hoped it would go away...and it didn't. Then I realized I should get health insurance in case it got worse. Please keep in mind that I have NEVER saw a doctor or health care professional about my knee. I found out today that my insurance is active and I want to see an orthopedic MD right away. My question is this: If I go to the doctor and get something done (like an MRI) would the insurance company try to argue that a potential injury is a pre-existing condition b/c the pain started b4 the insurance?

Please keep in mind that the glossary insurance company's definition of a pre-existing condition is: " Any medical condition or injury for which medical advice, diagnosis, care or treatment, including the use of prescription drugs was recommended or received from a healthcare professional during the six (6) months immediately preceding the effective date of your medical insurance coverage."

Answer 1

First off, I would not worry about the what the insurance company feels. I would do whatever it took to get myself treated. If it makes you feel any better, think about the $125 million a year compensation the CEO of United Health Care makes.

http://hcrenewal.blogspot.com/2005/05/how-can-1248-million-year-ceo-make.html

Second, you do not have a pre-existing condition based upon that definition. Nothing has been diagnosed, treated, or cared for so therefore it is a new condition and not a pre-existing one. Lets take an easy example, you see a doctor and he finds that you have high blood pressure. You probably have had high blood pressure for a while already and is only being diagnosed now. This is a newly diagnosed condition not a pre-existing one even though you had high blood pressure before seeing the doctor. Just because you have pain before seeing the doctor doesn't mean it is a pre-existing condition because the cause of the pain has never been diagnosed.

Third, sorry to say that your insurance sounds like a PPO or POS. (since you can directly go see an orthropedic doctor.) Don't forget that even with insurance especially a PPO you have a deductable (its like car insurance). You are responsible for the first $250,500,1000 or whatever you deductable is. Once your deductable is met, the insurance picks up a percentage of the cost (90%/10%, 80%/20%, 70%/30% etc your share being the later percentage.

So good luck

Answer 2

The only way they could know it was a pre-existing condition is if you saw a doctor, had the MRI and received treatment BEFORE your insurance went into effect. As long as you get diagnosed and receive treatment AFTER the effective date of your insurance, you're fine. Your last paragraph says it all: "during the 6 months immediately preceeding the effective date..." If you got treated tomorrow and the insurance went into effect the day AFTER tomorrow, then yes, it would be considered a "pre-existing condition". Wait until a few days after the effective date and then see a doctor. Hope this helps.

Answer 3

From what I understand, a pre-exsisting condition is a condition you have actually been diagnosed and treated for.So if you have not been treated or diagnosed before getting your indurance you should be fine. however, most insurances will try to get out of apying anything major, so you might have to prove that you havent sought treatment for that before, which you havent so that should be easy.

Answer 4

If you have never seen a health professional for it before then no it is not pre-existing. I probably would not tell the dr. how long it has been hurting though

Answer 5

No, it is not a pre-existing condition. It is knee pain, now see a doctor and get it fixed.

Answer 6

Well since you never received a diagnosis prior to getting your insurance, then you should be covered. Besides, how would they know if you had the pain before or not?

Answer 7

then i suggest you tell the doctor the pain started the day before you came in his office they cannot argue that point you had never been seen by a doctor for this injury no worries go and good luck!

Answer 8

No, if you have not been treated for and diagnosed, it is not a pre-existing condition. But if they ask about conditions, I definitely would not mention it, lol.

Answer 9

No, it is only considered pre-existing if it has been diagnosed by a doctor.

Answer 10

As long as u haven't been treated for it, who's to know?