Question:
Was approved by insurance. Now denied for pre existing cond
I have been approved for WLS for a month but was notified by my Dr's office today that they backed out for a pre existing condition. The only problems I've had over the last couple of years have been high blood pressure. It would seem like that would be helped by the surgery. I changed jobs 6 mos ago and took a month off at that time. Does anyone have any advice. I don't know what to tell them when I call tomorrow. Please help!! — Jolie M. (posted on June 19, 2001)
June 19, 2001
When you call them be sure and ask specifically what conditon it is that
they are rejecting you for. I can't believe that it would be for high
blood pressure because that is one of the main reasons why doctors want
this surgery performed. Must be something else. Just come right and ask.
You have a right to know. Don't be bashful.
— Penny J.
June 19, 2001
Funny you should mention that. I was just tonight revewing my old medical
files and found the records for my breast reduction in 1992. I got it six
months after I started a new job. The insurance company tried to deny
coverage for a pre-existing condition based on their policy which stated
"conditions for which you have sought treatment within twelve months
prior to coverage." I remember the battle I had with them! I had
never sought "treatment" for large breasts, but I had had large
breasts. Apparently, their argument was simply the fact that I had had
breasts prior to gaining coverage and subsequently wanted them
"treated" made the mere existence of my breasts a
"pre-existing condition! I wrote a rather sarcastic letter
apologizing for the fact that I had breasts prior to getting coverage, but
since I was born female, there was little I could do about it. About a
month later they finally paid up! :)
I don't know if that helps you, but make sure you read their policy to the
letter and then grill them about EXACTLY what they are defining as your
"pre-existing" condition. They may be considering your previous
attempts at weight loss as "seeking treatment" for a pre-existing
condition.
(p.s. for anyone who might know: I thought insurance companies were not
allowed to deny based on pre-existing? or is that only certain states or
group coverage?)
— [Anonymous]
June 19, 2001
It is my understanding that they can not deny for pre-existing if you had
medical coverage up to the date your new policy became effective. In other
words, if you had insurance before you went with them, they can't deny you.
You need to get a letter from your previous carrier indicating dates of
coverage. Hope this helps.
— Helen C.
June 19, 2001
Get a copy of your policy and read their written criteria for pre-existing
conditions. my bcbs stated if you seen a dr. regarding the condition within
six months of getting insurance. I called the insurance company and
specifically asked them about it. They said as long as i had not seen a dr.
and specifically talked about "weight loss surgery" it was not a
pre-exising condition. Also, if you had insurance prior to this insurance
with less than 63 days apart the insurance company had to cover you for the
conditions you were being previously treated for. So...unless you went to a
dr. within their time limitation and someone either you or the dr. brought
up wls and it was documented they can't use that against you. I would send
a letter of appeal if i were you. Good luck
— paula B.
June 19, 2001
I was not approved nor denied due to their checking into my
"pre-existing". I finally was approved. Afterwards, the nurse
at my surgeon's office had just attended a conference concerning insurance
and WLS. She said that insurance companies can no longer treat obesity as
a pre-existing condition! So I would contact the office and nicely ask
just what exactly they are considering to be your pre-existing condition.
Take it from there.
— [Anonymous]
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