Pre-existing clause?

Hey All !              I have been with my employer for 11 months now and have Aetna POS II Choice. I started the whole WLS road back in April by having a physical with my PCP. I have been going to all of my appointments that the surgeon asked for and now the insurance company has been giving me issues. They stopped paying for even simple office visits and say these were pre-existing medical conditions. I need to prove to them that I had health insurance before them and send documentation.  I had health insurance for the past 12 years but there was a 3 month gap when I changed jobs. They call it a 12 month exclusion......anyone had to deal with this????HELP Thanks

Did you have Cobra or any type of coverage during those 3 months. I know my job 3 years ago when I started, I believe they waived the pre-existing clause for new employees. And when we've changed insuracnes it's been waived.

So if I understand you correctly you started with your company in October of last year, &  at that time  you enrolled with the ins.  So from the time you started to your 1st appt was 6 mos correct?  And you hadn't been seen during that period for the diagnosis, the PCP or  Surgeon used? It isn't right that they are doing it, but your employer may also have a stipulation in their policy for pre-existing conditions.  You need to check your plan benefits booklet carefully.  Also, have you called Aetna, this may ******ror on their part.   Believe me I've seen it happen as I used to work for them.  Sorry I couldn't be more help.   Kerri

Thanks for trying - To clarify it a bit - I started last Oct 2 at my new job I had to wait 90 days to have my benefits kick in. Which brought me to about Jan 1 2007 - I went to my new PCP in April 07 and began working toward WLS in May 07. Everything was fine for my first visit or 2 then my claims we all pending due to pre-existing condition paperwork needed. I had insurance for the past 12 years non stop except for when I left my last job to come to this one. I left my old job July 15, 2006 and started my new one Oct 2, 2006. In all my years of insurance I think I went to the doctors maybe 2x and now everything is pre-existing? Is there anyway around this hipaa clause?

I thought pre-existing was only conditions you had sought treatment for in the 3 months prior to starting with your insurance...so when was the last time you went to a doc for obesity before you started your new job? Sounds to me like you have at leasat 6 month....3 months between jobs and 3 months probation you wait for benefits to kick in....

I think I would try to fight it if you hadn't been seen for the same diagnosis in the six months prior to your 1st appointment.  Did you even go to the Dr in that time frame?  Maybe your dr could send a letter to the ins if you are an established pt, or been going to the same one for many years, that states you had not been seen for this condition prior to the 1st date?  Just a thought.  Kerri