Question:
Pre-existing Condition??

I relocated and have been without insurance for a couple of years. My employer finally got group insurance, and I have coverage. The pre-existing condition says "A pre-existing condition exclusion may only relate to conditions manifesting in symptoms that would cause an ordinarily prudent person to seek medical advice, diagnosis, care or treatment or for which medical advice, diagnosis, care or treatment was recommended or recieved during the 12 months preceeding the date of application." It goes on to say "This means that a person has a pre-existing condition if, during the 12 months preceding the date of application, the person either 1)has seen a doctor or other medical professional for a specific condition, or 2)has had symptoms for which the average person would have seen a doctor or other medical professional, even if the person has not seen a doctor or other medical professional." I have not seen a doctor in the last 12 months for anything other than a sinus infection. Does this mean that they will not cover the surgery, is MO considered a pre-existing condition?    — NascarFan #29 (posted on January 27, 2003)

January 27, 2003
Hi! I read your pre-existing question. I thought I was going to have a hard time with this issue as well. My husband was unemployed for six months, during which time we had no coverage. Some companies do take into consideration -the lapse of time you weren't covered before the new policy and also whatever they presume to be a pre-existing condition excluding pregnancy)It's hard to tell what they will consider pre-existing?? If for any reason you are turned down approval for those circumstances, they may require a 1 year waiting period. However you may want to check with your benefits officer and find out if that clause has been waived. Much to my surprise this clause was waived by my husbands employer. We just picked up the policy Jan.1 this year and just found out today that I have been approved for the surgery (March 28) I've already been given a date. I am confused about the pre-existing clauses but I don't believe that MO is considered a pre-existing condition unless you have seen a doc for or have been treated for anything relating to MO within the last few years. Again, it may just depend on your specific insurer and what your employer has opted for in the group health coverage benefits. I hope this helps
   — lyndaleigh