Question:
My current insurance doesn't cover WLS. I have had my first appt. w/ doctor
and I think they submitted the bill for initial appt. to insurance even though there is a written exclusion. If I were to change insurance companies now to a policy that covers WLS, would it now be considered a pre-existing condition because of that appt.? — [Anonymous] (posted on January 12, 2002)
January 12, 2002
When I started my new job I had a choice of 2 insurances and the one I
thought would cover the surgery I could not get because of pre exsisting
conditions, the other one covered me no matter what, and they paid for the
surgery with no problems at all. It cost me the $10.00 co-pays. If they
have a pre existing clause they won't pay for anything you have been to Dr.
for in past 3 months. If your employer is switching I think they have to
cover you for all health problems. I have Humanna HMO and no problems I was
really suprised, Good Luck
— KAREN T.
January 12, 2002
It was also my undestanding that congress passes new legislation making
insurance companies cover this type of surgery. Contact your local
congressman!!! Another resource to look into is the Department of
Rehabilitation. Commonly referred to as Voc Rehab. If your weight is
preventing you from working or getting a job, etc, they might be able to
cover it.
— [Anonymous]
January 12, 2002
It may very well be worth getting a COBRA policy from your current
insurance, and going through the appeal process with them. I am in a
similar situation and am considering keeping my current insurance COBRA
just in case I may need some follow-up or emergency treatment after
surgery. My job is most likely going to be phased out by late spring and
I'm hoping to have had surgery and a couple of weeks recovery time by then,
but you never know! Good Luck to You!
— [Anonymous]
January 13, 2002
I believe that if you have been covered under your current plan for the
last consecutive 12 mos. and switch insurance either because of a new job
or open enrollment AND there hasn't been more than a 30 day lapse in
coverage...then they CANNOT get you with a pre-existing condition. You
have to supply the new insurance company with a certificate of
"credible coverage" showing that you were covered continuously
over the last 12 mos. I am very confident that is how the system
works...it is federal law. If your plan is to change jobs, you should be
able to get COBRA to cover until the new insurance begins. That would keep
you continuously covered. If I am wrong...someone e mail me and let me
know...But, I think this is correct.
— Karen B.
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