Pre-Existing Condition??

Ok, so i called my current PCP's office under my Aetna plan to get referrals sent out to the specialists i need to see for the pre-op testing. She told me that i should be careful because If i am treated by or seen by a specialist under Aetna, that once i switch to Oxford on the 1st of April, they may not cover me or my surgery, because my obesity will be considered a "pre -existing condition". has anyone run into this problem? Can i get referrals from my Aetna PCP, and then go to my appt with my Oxford insurance? Or should i wait till my Oxford is effective, and then go to that PCP for my referrals? Im confused.

Ana~ For the sake of a few days, I would wait. Just in case, it's not a long time away, just a few days at this point. I think the Aetna person is wrong, you won't be excluded for a pre existing condition, as long as there is no lap in coverage, and there isn't in this case. But, better safe than sorry. Wait until Tuesday to make any calls, at least that is what I would be doing. This is way too important, and way too expensive to take a chance with. Your new life will be worth it! Michelle Brennan

Of course i know you are right. I am just so excited to get this show on the road that i am acting over impatient. LOL. Thanks for the response. I hope that there arent any problems. As for the person who suggested calling Oxford. I thought of that as well, but they dont list a # on their website for members to call. They say to refer to the ID card, which i dont have yet. And when i called the contact that is handling our policy processing, he gave me a # to call, and they said that since all policies vary greatly depending on company , etc. they couldnt give me any solid info and wouldnt even tell me on average what the guidelines were for WLS. So i have to wait until i get my ID card at this point. Its frustrating, but like you said, at this point, it should be a week, tops.. I say a week, because the contact handling our policy with Oxford said the underwriters are backed up and we may not even get our card next week. So.. oh well..

For most insurance you can have the pre existing clause waived if you have had continuous coverage for more than 6months before coverage started. Try calling Oxford and getting the facts not just taking one persons word. I have experience in this field not just talking out of school Good Luck either way

OK....I know the answer to the Oxford question because I just had to go through this. On their web site , if you scroll to the bottom, click on "member", then to the right on "practical resourses", then "Medical & Administrative policies", then "policy index", finally scroll down to "Pre-existing conditions"; you will find that Oxford (paraphrase) "is not responsible for pre-existing medical problems if you have had a lapse in coverage and/or have had your prior insurance company for less than 18 months". Meaning as long as you had Aetna for longer than 18 months, you shouldn't have any issues. I found this out when I was denied my surgery by Horizon due to not having the policy for one year. When I inquired with Oxford about switching, it was worse....I'd have had to wait another whole year since I hadn't had Horizon for 18 months. I agree with what's been suggested here. Simply wait for your new policy to take affect. Good luck Lisa

OH MY GOD. YOU ARE A LIFE SAVER. I PRINTED OUT THE PRE-EXISTING POLICY TO READ OVER. There is some fine print that i have to read through. I have switched jobs so often in the past 2 years that i think i may not be qualified to recieve coverage for the surgery. But i will wait and talk to someone. See, from February of 2006-Oct 06 i worked at one company, but i was in a 3 month probationary period where we had no insurance. But after the 90 days, i had Aetna PPO. Before that job, i worked at a company that started me on insurance from day one, and that was Aetna as well, and then HealthNet or something. I forget. and i am currently in a NJ Small Group plan i believe for Aetna HMO which took effect in Jan? Bear with me i am thinking out loud. lol. Ok, well IF they deem it to be a pre-existing condition, it states in the policy, " Oxford can apply a pre-existing condition limitation no more than 180 days after the members enrollment date." So.. what is that 6 months?? not as bad as waiting a whole yr.. sigh. we shall see but thank you for all the responses. i am glad to finally have some reading material.

That is correct. By Federal law, as long as you have not had a lapse in coverage of longer than 30 days, the maximum time for which a pre-existing condition can be excluded is 6 months; if your coverage HAS lapsed, it can be excluded for up to a year.

Whew. I am so glad i made my doc appts with Oxford. And its a good thing my surgeon takes Oxford as well. I think everything is back on track. As soon as i get my ID card, i am going to call Oxford just to go through everything and verify with someone. Thanks everyone for your responses. I feel so much better now.

hi Ana just to make sure of everything and to not waste time and money -- please don't schedule any test until you get your approval for surgery -- there is no sense in going thru a bunch of testing if you get denied for some stupid reason and then you might have to take the test again -- sit tight on your testing -- you will have plenty of time to schedule everything after you are approved good luck roberta

Slotman wont submit my paperwork to get approved until i complete the tests he wants me to get.. so for instance, my Upper Gi test is very important, in getting the ball rolling. But the woman who posted info on Oxford helped me out a great deal. I found out all i need to know. And i am relieved! whew. i found out that i dont even need a psych eval! woohoo. Thanks for the response though Roberta! i love this message board. loll