Question:
~In Need of some In Put~

Well anyone that knows me from here, knows ive been fighting my insurance for over 4 months now (John Alden Health) And im on my first appeal still, wating for a answer, but sure that they will deny me. ok well here is a new twist to my story, and Im really in need of some input about it. My husband has been offered another job, in another town, and with different insurance. The new insurance is Paramount Insurance,and is a HMO. Ive not seen the new policy yet, but am anxiously awaiting it to see if maybe just maybe they do cover WLS.(Im Hoping So !) Ok well anyway, Im not sure how this is gonna work then, And would love some information on what I would do.Ok If the New insurance Does cover it, Is there a waiting period, And what about the fact that my old insurance has denied this procedure(even though they say it is ONLY Because of their exclusion clause). The other thing is now im really worried that they (Paramount) will not cover it either...So im really getting very nerveous, and not sure what I have to do, or should do at this point. Should I Continue my fight with John Alden, Or Not??? Im sure once my husband gives notice to his employers that the insurance is not gonna wanna pay for this surgery with the fact we wont have their coverage anymore..*Sigh* Im So confused...I Dont know if this is a good thing, or really a bad thing. I looked up information on the insurer on this site, and One person was approved with paramount, but the other was paramount HMO and was denied..So Now im really Scared...Any Advice would be appreciated....Sorry im rambling so...:o)    — Ann A. (posted on March 28, 2000)

March 28, 2000
This sounds very similar to my experience. My insurance company wouldn't cover weight loss surgery, and I fought with them on it for several months before my husband got a new job and new insurance company. Luckily, the new insurance was CIGNA ppo which gave me an easy approval. Don't worry about waiting periods or pre-existing conditions. The federal law called HIPAA takes care of that. If you are changing from one insurance company to another, do not go without insurance for more that 63 days. As long as you have less than 63 days in between policies, your coverage is considered continuous, and your new insurance company can't refuse to pay for pre-existing conditions. They may require a certificate verifying your past coverage. Here's a link explaining the law: http://www.dol.gov/dol/pwba/public/pubs/hippa.pdf A lot of it is hard to understand, since it is a federal law, but it turned out to be a big help for me.
   — Lynn K.

December 18, 2001
I also have Paramount HMO, and they have a written exclusion policy. I am working with a local attorney who specializes in medical appeals. I will keep you posted of furture developments. Remember, when a door closes somewhere a window opens.
   — Diane P.