If I haven’t been diagnosed with a previous condition, do I have to report to the new insurance company my concerns?

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Sep 1, 2010

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Insurance Question from Mesquite, TX

Asked on 09/01/2010

If I haven’t been diagnosed with a previous condition, do I have to report to the new insurance company my concerns? I had a mammogram at the beginning of the month when I had insurance. I changed jobs and therefore lost my insurance. I have been notified that my report shows that my right breast are dense and they want to do diagnostic testing.

Answer given on September 02, 2010

I don’t know your situation without a few more details, but here are some things that can happen based on several sets of circumstances: 


1)  Your new job has insurance for you.  

If this is the case, they can’t pre-x you out as long as you don’t go more than 63 days without coverage.  That said, you may have to continue on with COBRA from your last job if you have to wait to get on your new employer’s plan.


2)  Your new job doesn’t have insurance at all.  

If this is the case, you’ll want to go on with COBRA.  Always be honest when filling out an application.  It can come back to haunt you later on, in a very expensive way, if anything ever comes from your mammogram testing.  


3)  Your new job has insurance but the new insurance doesn’t cover diagnostics ( this is highly unlikely ).  

I only bring this up because this can happen in some circumstances.  Don’t assume that your new insurance is exactly the same as your old plan, ever.  And be aware that “covered” can mean a lot of different things.  


Hopefully, your new job has insurance and you can continue on with no gaps.  If that is the case, and you are less than 63 days without coverage, they can’t pre-x you for anything.  Technically, they could say that the mammogram results showed there was a concern, even though there is no specific diagnosis as to what that concern might be.  It could be nothing, or it could be something to raise concern.  Either way, your best bet is to state that you recently had some testing done and further diagnostics are required, even though there is no actual diagnosis.  They can’t pre-x you, but they can deny based on false information, even if it isn’t intentional on your part.  


Good luck!

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