should I have a referral just prior to insurance change?? doesnt seem right

[sunidol]

For the past 3 years I have been seeing a GP for chronic neck and back pain. Now all of a sudden she wants to refer me to an ortho surgeon and pain med specialist. My problem is this .... I am getting ready to change jobs (very soon) and change health insurance....I am afraid that if I see an orthopedic specialist NOW, on my current insurance, my new insurance will consider it a pre- exisiting condition and won't cover anything at all, meds, surgeries, injections, whatever.... Should I ask her to wait for a referral until after I change insurance? Or is it all ready too late by simply having had xrays taken ( 2 years ago) which shows spinal problems? plus I'm not sure she is willing to wait for the referral...

Any ideas? please?

sunny

[itsmejuli]

I used to work as a medical claims analyst for a large medical insurance company.

Generally, if you've had continuous medical insurance coverage for more than a year then pre-existing conditions shouldn't apply under your new policy. When you cancel your current coverage you should receive a letter from the insurer indicating the number of days of continuous coverage.

You should contact your new employer's HR and find out what the waiting time is for coverage under their group plan as well as what their pre-existing policy is. Some companies have waiting periods and some have specific policies regarding pre-existing conditions and the time required for continuous coverage under the previous plan.

I'd find out all of the above before booking an appointment with a specialist. It would suck to go to the specialist under your current policy only to find out that the specialist doesn't accept the new insurance. Then you'd have to start all over again.

Hope this helps.

[gr8rnpjt, RN]

Part of HIPAA includes regulations for Health insurance portability. It pretty much removes the ability for a new insurance company to include pre existing condition penalties. You can no longer be penalized for having a pre existing condition.

You may want to check, if you know who your insurance company will be, if the specialist is in network or out of network as it may affect how much of a copay you will be required to spend. If you don't know about your new insurance company, you may want to wait till you know more about in network physicians before you start with a specialist. I would hold off for that reason, if physically and medically possible.