Question:
What do I do if the Insurance Company denys me due to a pre existing condition

On 2-27-01 I was denied approval for my procedure with my Doctor. Their reason was because of a "Pre-existing condition" so they say. The only reason why they denied me was because prior to me attaining their insurance, I went to one of these non-referral weight loss doctor centers(Doctors Choice Weight Loss) to see if maybe the "medication thing" would work for me. This is OUTRAGEOUS!!! I am going through a serious state of depression and I am very discouraged about this whole thing now. I am still wanting very very much to have this surgery, but because of this sorry insurance company I have(BCBS Trigon) I have to wait until after 10-02-01 to have this surgery. Right now, money is becoming a problem for me and $350-$400 is a lot coming out of my pocket. Now if Mr. Lindstrom can somehow guarantee approval after this appeal letter is done, then I will scrap up the money. Can Obesity Law still help me?    — gretadavis (posted on April 26, 2001)


April 26, 2001
I just read something about pre existing limitations. It said that Clinton passed a law that said if you went directly from one insurance to another that they couldn't use that. So did you have coverage prior to this policy? If not, It might just be a waiting game. They can only use this for a certain ammount of time before they'll cover stuff, maybe a year, not sure about that. good luck........
   — [Anonymous]

April 26, 2001
As long as you have had continuous insurance coverage (no more than a 30 day lapse between coverage), they cannot deny you based on a pre-existing condition. If you had a lapse in coverage, they can only deny you for as long as the lapse was.
   — PT LawMom

April 26, 2001
FIRST OF ALL, DO NOT GIVE UP!!! I went thru the very same thing with bc bs of texas and I fought it. This is what you do first ask for the insurance company's determination in writing. Let them know it is not consider a pre existing unless you have received any type of treatment or had the surgery in the past 6 month to year. And if that does not work let them know that you will call your state department of insurance. They had for them to get involved. Keep calling and demanding to speak with the person that may this determination. Sometimes new insurance companies will get the information from your last insurance company and use it against you. DO NOT GIVE UP!!! I did not and my surgery is 4/27/01. Please e mail directly if I can help with this process. You have to be very determined when dealing with the insurance companies, especially bc/bs
   — LANIE M.

April 26, 2001
As a confirmation, yes, during the Clinton administration a law was passed that removed the "pre-existing" issue from new insurance coverage if you did not have a break of more than 30 calendar days. For example, I was covered by Cigna and denied for WLS and transferred my insurance on December 1, 2000 to Trigon. I had to go to my PCP and get a new referral but I was approved for surgery approximately December 5, 2000. Additionally, if you find any attorney that will guarentee that their services will get you approved...well, there is a name for that type of attorney! Mr. Lindstrom does not fall in that category. Attorneys will try to help and others are more familiar with obesity and insurance law than others but none should offer you a promise of positive results. On a final note, have you consulted with your physician as to how long his waiting list is for surgical dates. My doctor is currently scheduling into October. If your doctor is one with a long waiting list, you might be smart to go ahead and get on it, jump through the insurance hoops or simply wait out the next 5 months. I put my waiting to good use and became more educated on WLS and nutrition. I figured that since this was a life long committment, what was a few extra months to just strengthen my resolve to a better life.
   — smummert




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