Question:
I heard somewhere the preexsisting is illiegal when it comes morbid obesity...
I am sure this has been asked before, but I assure you that I looked and could not find anything about it- Is it true that by law your obesity can not to considered pre-exsisting? That is now my only concern with getting approved. And I'm not sure if its a plus or a negative that I have never seen a doctor for my morbid obesity. I was thinking that was good since they couldn't scream "PRE-EXSISTING CONDITION" but on the other hand it showed no serious problems. What do you think? Thanks! — karmiausnic (posted on June 8, 2002)
June 8, 2002
I am not sure if it's illegal or not but I know that my doctor's bill was
rejected by my old insurance company for claims because he diagnosed me as
morbidly obese. There is a plus and a negative to not having gone to a
doctor yet for your morbid obesity. I know that if you've received any
medical advice or treatment for a condition before you got your insurance,
there will be a pre-existing conditions clause.UNLESS you had insurance
before that without a 62 day break If you didn't receive any advice or
treatment, then you can treat under your insurance for that condition and
the insurance company has no right to deny you. However, when insurance
companies approve WLS, they require 6months or sometimes, depending on your
insurance company, up to 5 years of medically supervised dieting. and
sometimes even want proof that you've been morbidly obese for over 5
years...something like that. Someone please correct me if I'm wrong. I was
in the same exact situation with my old insurance. I quickly cancelled it
because I wasn't patient enough to wait a whole 6 months. That was last
year and I'm still pre-op. Now I have insurance that has no pre-existing
conditions clause and has a good record of paying for this surgery. I just
hope rules don't change before I have mine lol. Good luck to you!
— Samar M.
June 8, 2002
My (limited) understanding about health insurance is that as long as you
don't let your health insurance lapse for a certain number of days, there
is no such thing as "pre-existing" for ANY condition anymore. We
can thank President Clinton for this! It's one of the few things that he
proposed in his National Healthcare Bill that passed.
— Kristie B.
June 9, 2002
I would say that if you don't have a gap in the insurance you would be
better off having seen a doctor for MO because it does show a specific
history. On the other hand, if you have a gap its probably best that you
haven't. I had a pre-existing waiting period with my current insurance but
because I had never seen a doctor specifically for my weight, it didn't
affect my approval for WLS. In this situation, the key would be that you
never got DIAGNOSED with MO (within the last 6 months or a year, I can't
remember which) but that your records still indicate your weight as being
within that range. Basically, show the weight was there, but no codes fo
MO were submitted to insurance or anything. That's what worked for me,
anyway. Good luck!! =)
— K. Joyce Smith
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