Insurance fraud??

Ok, so I got that new job, with insurance. Yeah!! Not so... I have been paying out 300.00 + a month for insurance, bcbs ppo. Guess what??? They have a pre-existing condition clause, which means that if I have complications due to my surgery, its NOT covered for 18 months, on any of the plans my job offers. I searched my plan and it doesn't say a word about pre-existing conditions, you must actually ask if they have any exceptions to find out. I found this out when I ordered my allergy serum for my allergy shots and then the next month I had to visit my family doctor for a cold. The doctor put my cold in as being allergy related and now I am paying 470.00 for those two, while I still have the monthly premiums. The way they get around this? They say its HIPPA regulations and that if your previous coverage had a lapse of 62 days before picking up the new insurance, they don't have to cover your pre-existing conditions. Well, I fall under that catagory, because my husband lost his job and we also lost our coverage for a year, then I picked up my new insurance from my new job. I find all this rather strange, who in the world knows to ask this type of question?? Also, if my place of employment doesn't even know, how can I possibly know?? The moral of my story.... if you have had this life saving surgery, please check your new or current insurance plan to make sure they haven't screwed you over too. I am still happy and thankful that I had this surgery, but I am so upset to think that if I should need to have an emergency surgery due to a complication, it will be out of pocket. I will not risk my health/life so I will pay for it somehow, but I will not pay insurance for nothing. I just wanted everyone to be aware of this, just in case. Take care! Tami 275/163/145

Hi Tami, Thanks for letting us know. I would have no idea to ask these questions. Teah

Yes, those pre-existing conditions can sometimes bite you in the butt! To make matters worse, insurance companies don't like to provide you ANYTHING in writing. Next month, I am going to a fertility doctor. According to the booklet my husband got from work, ALL fertility treatments are covered (except for in vitro and IUI). To me, ALL treatments includes drug therapy, especially considering there are no exclusions to that effect. But the insurance people say "Nope." BUT, when I asked for a copy of our policy, they REFUSED. SOOO....It is my belief that insurance companies like to make up their own little rules as they go along and keep the customers in the dark. They pretty much have a "don't ask, don't tell" policy, which REALLY means "don't file a claim, don't pay a claim." It's one big conspiracy...no wonder healthcare is going down the toilet! I hope that everything works out for you! Pamela

Send them a letter in writing asking for the policy in writing. My RE gave me a booklet that has a sample letter in it to send for just that case. It is very good. If you need a copy of it, let me know. His entire booklet was on making sure you get insurance to pay for everything you are entitled to. I have to have surgery in the next few weeks because there is something weird going on with one of my tubes. He wants to see if I have adhesions or anything that are getting in the way. Not looking forward to the process. Good luck with your treatments and hopefully you and your hubby will have a baby in the not so near future.

I've been dealing with insurance regarding this whole pre-existing condition clause. In my case, I didn't have insurance for about six months after moving to Ohio until I got married last fall. At that point, I made appointments to get establisted with new doctors here and everything. I saw a doctor on Dec 27 that wanted to do some follow-up work. On Jan. 1, I was eligible for insurance from my own job so we signed up for that being told that my work insurance would be my primary, hubby's would now be my secondary. Because I was at the doctor 3 days before that took affect, they had refused to pay for any of the following treatments. It has been a huge fight. Finally last week, I got them to accept my proof of credible coverage from the secondary insurance to pay any of the claims. It's been a mess. One thing I've learned from it all, is you've had to have been diagnosed with a certain CPT code in the last 3 (sometimes 6 months depending on the company) for it to be considered a pre-existing condition. So for example, they covered my lab work in January that my surgeon has a standing order on because those diagnosis codes hadn't be used for me for more than six months. (It had been seven.) I'm sorry you're going through this with your allergy meds. Insurance companies can be so frustrating. Jen