Friday, July 07, 2017

From the Mailbag: CTE or no CTE?

Interesting query from a reader:

"My sister went to the doctor because of some symptoms she's been having (memory loss, moodiness and headaches). She's a cyclist, and used to race competitively, and suffered concussions in the past. The doctor thinks she could possibly have CTE. She hasn't done any testing because from what she knows there's no treatment for it.

She does have health insurance through her spouse's employer, but wants to know if she gets this testing and it's in her records that she has CTE could that hurt her in the future for insurance purposes? Like if she has to switch insurance companies etc.

I know right now it wouldn't matter because of ACA. But what if things change if/when they repeal it? The way I always understood pre-existing conditions before ACA was that you could not have a gap in coverage. So if you have insurance and you're diagnosed with a condition you are covered. If you switch insurance and there is no gap in coverage it can't be considered a pre-existing condition. But if you do have a gap in coverage it could fall under pre-existing conditions. Is that how it worked before? Who knows how insurance is going to change in the future. She's just trying to figure out if she should just not do it and wait and see

First, Thank You for a really outstanding, well thought out query. There's a lot to unpack, so I'll try to be as thorough as possible.

Here's the thing: we really don't know what's going to happen (or when, or even if) ACA-wise. If we go back to something that looks like pre-ACA, then yes, this is a legitimate concern. But the cat's already out of that bag:

"went to the doctor because of some symptoms she's been having"

Assuming new applications look like pre-ACA, then she's going to have to answer yes to at least one of the questions ("have you consulted a physician"). It may not be explicitly CTE, but it's likely going to be an issue, although I have no idea how much of one. But: this presumes a new app. Again, assuming something that looks like 2009, as long as she keeps continuous coverage group-to-group (or COBRA), no problem. However: that only really worked individual-to-group, or group-to-group, not group-to-individual (or individual-to-individual).

From what I've read, CTE is kinda like Alzheimer's in that it's only truly diagnosable at autopsy. While alive we're only able to infer its presence. So test or not? I don't know, but I would suggest taking the insurance element out of the equation, and look only at pro's/con's of "knowing."

Hope this helps, and best of luck to your sister-in-law and her family.
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