Question:
Starting my work-up Before my new ins coverage begins??
I have decided to go with my husbands PPO provider for my ins as well. And then drop mine, since it lists in it's exclusions NO weight loss surgery of any kind for any reason. I can find no such exclusion in the information that we were given on his PPO plan. They do however state that they have No pre-existing condition clauses in their policy. I had called their customer service # to see if an RNY would be covered if medically necessary and they said no it would not. However I'm going to try and get it through them anyway since my coverage said they won't in writing in their exclusions. My question is this....I have an appt with a surgeon Dec 2nd and I would like to keep that and start my work ups now. I realize that I will have to pay out of pocket for the appts and tests now because the ins coverage doesn't take effect until Jan 1 2000. But I hate to wait until then to get everything started. Then I could just have it submitted after the 1st of Jan for the surgery. Do you think that it would cause any problems with being approved for the surgery? Because I started my work-ups before coverage began? I don't want to cause myself anymore problems getting approval then I will already have. thanks, Deb C — Deb C. (posted on November 4, 1999)
November 3, 1999
Hello Deb. I know you want this to go fast for you but if you go to the
doctor before your insurance get started you have put up a wall that you
will not be able to get down with the insurance co. Then they can call it
pre-existing.I worked in insurance before I quit work. I repeat no not go
for this or anything that is about your obesity problem until your
insurance is in effect. GOOD LUCK!!!!!!!!
— Patricia B.
November 3, 1999
Hi there....It is my understanding that according to a
federal law regarding insurance companies and pre-existing
conditions, if you are switching from one group insurance
company to another (both being offered by your or your
spouses employer) the pre-existing conditions rules DO NOT
apply. Pre-existing conditions only come into effect if
you currently don't have ANY insurance coverage at all and
are joining a group policy through your employer, or are
joining a private policy that you have chosen. The way I
understand it is that if you are switching from one group
policy to another, the new policy has to act like you have
been covered by them during the time you had coverage under
your old group policy. I don't think you have anything to
worry about, but the very BEST way that you can find out is
to call the information number on the new insurance and find
out if there is a pre-existing conditions clause if you are
SWITCHING to them from another group policy. Good luck!
— [Anonymous]
November 4, 1999
I may not be understanding what you are saying very well but if you have
two insurances(yours and your husbands) and you are changing your primary
insurance to the same one as your husbands then you have nothing to worry
about. Are you on your husband's policy? There is a law called the HIPPA
(something like that) law that requires insurance companies to waive the
pre-existing clause if there is prior coverage for a length of 6 months or
it may be 12 months. Just try to make sure there isn't a break in your
insurance coverage. Good luck.
— SherP
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