Can an insurance company exclude long-term complications of WLS?
My HMO has a policy of excluding coverage for any complications arising from a non-covered surgical procedure. In other words, if I self-pay for WLS, they are telling me that they will not cover ANY post-op problems I might have, whether the problems occur while I'm in the hospital or five years later. If I have a bowel obstruction 18 months after the DS and need an emergency operation, my HMO is trying to tell me that I'll be on my own, because they wouldn't have approved the WLS if I'd gone through them. This is very scary to me. Does anyone have any information about whether an insurance company is within their rights to permanently exclude late-term problems like that? Should I try to switch to another HMO (my job offers a choice of two HMOs and that's it) so that my "new anatomy" can be considered a pre-existing condition? Would that get around the problem? Do any of you happen to know what the law has to say about this kind of thing? I called the Florida Department of Insurance, and they said they didn't know... it's a gray area. I also wrote to Walter Lindstrom, hoping that he might be able to offer some information or advice.
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