Should she/shouldn't she

[Dad2]

Florida
If my daughter refuses to take radiation treatment after successful Chemo for Hodgkins and later has a re-occurrence of Hodgkins or another cancer develops, can the insurance company refuse to cover her claiming that she did not take the advice of her Radiologist by refusing the treatment he recommends? Radiation after successful Chemo is suspected of causing cancers later in life especially for young adults that have had Hodgkins particularly for those with a family history of breast and other cancers. Both of her grandmothers died of cancer - one had breast cancer. The Radiologist says that he understands her concern but says since the ‘standard’ protocol at this time is still radiation treatment, therefore he must recommend it. All of this is despite the fact that the Chemo Oncologist says all tests indicate all cancer has left her body. This, plus the assertions of many in the medical community that Radiation is a potential cause of later cancers and her family history, is why she is considering NOT having the Radiation. Unfortunately there are no completed clinical studies that can be sited at this time to confirm or reject the assertion. On the other hand she can not afford to go without coverage or be denied coverage in the future, should something occur. She faces an extremely difficult decision.What is the name of your state?

[cbg]

This is really not so much a legal issue, as it is an issue of the wording of the insurance policy.

If she is covered on an employer-sponsored group policy, then as long as she has had continuous coverage for 12 months or more and there is never a gap in her coverage for 63 days or longer, then under HIPAA the insurance plan cannot consider any condition pre-existing. (Even if she does have a gap or has not been covered for 12 months, the longest an employer-sponsored group policy can consider any condition pre-ex will be 12 months.)

However, for individual policies that law does not always apply.

[Dad2]

Hope I am doing this correctly ---- She is not covered by an employer plan - she has a HSA account - and is in good standing. The issue is if she refuses the radiation treatment and something comes up later can they say since you did not take the treatment we will now not cover treatment of a re-occurrence of the Hodgkins or any other cancer.

[ecmst12]

This isn't a pre-existing condition issue....and I suggest that your daughter ask her insurance company this question. She could also get a second opinion about whether she should have the radiation (from an oncologist). Then if the 2nd doctor thinks she shouldn't have it, when she declines the treatment it won't be against medical advice.

[cbg]

Well, it is actually at least in part a pre-ex question since it is rare that people remain on the same insurance forever and a new carrier is hardly going to be asking about treatment outside the pre-ex look-back period since they're not allowed to make any but underwriting decisions based on it anyway.

[Dad2]

Good suggestion - Thanks for the advice.