Question:
Iwas told my obesity was pre exsitng but I am required to be obes for 5 yrs or more.

This does not make any sense to me. I have been to Dr. over 2 yrs ago for diet meds. I have never been told or spoken to about wls. I never considered it. Now what do I do? I am at the end of my rope. Please help Christine    — Christine L. (posted on April 15, 2002)

April 15, 2002
I also have BCBS of DE. I have not sent in paperwork for approval yet, but my surgeon's office has contacted to check if covered etc. They were told 100%. I have only had BCBS of De since January 1st. If you have group insurance through an employer there may be a pre-existing clause but if you had insurance before that and it did not lapse for more than 30/60 days prior to signing up for BCBS then that time should go toward the qualifying time for pre-existing coverage (ex: I had insurance with Carelink for 9 months last year and that ended with signing up for BCBS making my pre-existing time now 3 months) My plan's pre-existing clause if only for 1 yr. 5 years is an awfully long time....I would double check this. If in fact this is correct and you do have a group plan through your employer I would make them aware of this problem....If its an individual policy that you have picked up then I would do some more research on other insurance plans....like I said 1 yr is pretty normal....5 yrs is ridiculous.
   — Donna M.

April 15, 2002
The requirement of having been obese for 5 years does not mean that you have to wait 5 years before you can have the surgery. This is how the pre-existing conditions clause works. If it's 6 months long, that means they won't treat the condition until those 6 months are up. If it's 3 months, then they won't treat it for 3 months. I guarantee it isn't 5 years. They are just requiring that you have been MO for at least 5 years to qualify for the surgery. Call your insurance and find out how long the pre-existing clause is for and how much longer it is until it's over.
   — garw

April 16, 2002
I would see a lawyer and take your contract and whatever paper work you have for him/her to see. It's CYA (Cover Your A##). I had Prudential insurance over 15 years ago and wanted to make sure another 'very important surgery' was covered (NOT WLS). Seeing the lawyer was one of the best things I did. In fact he was the one who said the "CYA". I've laughed for years over that. ;) Anyway, do CYA! Good luck!
   — Danmark

April 16, 2002
Check out the library, search for Maryland insurance laws. Maryland is one of four states that requires insurance companies to cover WLS under NIH guidelines. The pre-existing may still be an issue, but I'm almost positive the 5 years will not be. Please contact me at [email protected] and I will send you the links or try to get the information, this was important to me because my insurance is through a Maryland company.
   — cjabates

April 16, 2002
I don't think the 5 years is a pre-existing time. It comes from a few states that mandates that insurances must cover WLS if the patient has been morbidly obese for 5 years or longer. I am not sure about your specific state, but BC/BS does seem to do about anything it can to get out of covering WLS. Your profile says you have a bmi of 39, so you would only qualify under NIH criteria if you have serious medical problems related to obesity. Ask the insurance for the specific policy, (they may not want to give it to you, but legally you are entitled to have it.) And then if you have medical problems that would qualify you for WLS, then I would contact Walter Linstrom (obesitylaw.com) to see if they think you have a chance at getting approved. There rates are very reasonable and they are very familar with insurance and WLS.
   — Dell H.