Question:
Does insurance w/exclusions cover preexisting complications due to WLS?

I am scheduled for wls and gall bladder removal on 9/16. My husband was laid off in July but is not "officially terminated until 9/22. This means we have normal insurance until 9/22. Well, the first thing I did was get a job....and new insurance. The new insurance kicks in on 9/1. For a couple weeks we have double coverage....which hopefully isnt illegal. The knew insurance has a "no gettin around it" WLS exclusion. It also states that it will not cover any complications caused by noncovered procedures....So, say I have my surgery and show up 4 months later with a stricture....does this mean I'm out of luck? I know that they cover prexisting conditions if I produce a Hippa certificate (have that)...but will my surgery be considered preexisting since I'm in the two week overlap? I guess I'm hoping an insurance specialist will read this and know...or anyone in a similar situation. I figured that stricture and hernia are the most likely complications---and I can explain the hernia as caused by gall bladder removal but a stricture? I can go on cobra...but it is so expensive.. but I will do what I must to get the surgery.....J.Smith    — j S. (posted on August 28, 2002)

August 28, 2002
I worked in health insurance for about 15 years and if there is a pre exsisting exclusion this is usually the drill. You have to be treatment free, no medication, ofc visits, er visits, nothing for 90 days prior to coverage date. Ane most pre exsisting exclusions are only for a year. Good Luck!!!!!
   — Peggy A.

August 28, 2002

   — Rosario T.

August 28, 2002
Correct me if I am wrong, but, I think Clinton signed a law prior to leaving office that did away with pre-existing condition clauses
   — heathercross

August 28, 2002
Heidi - you're partially correct. Clinton signed HIPAA into law in 1996. HIPAA is the Health Insurance Portability and Accountability Act. Basically, what HIPAA does, is it offers new protection for Americans that improves portability and continuity of health insurance coverage. HIPAA Protects workers and families by Limiting (NOT ELIMINATING) exclusions for pre-ex medical conditions, Providing CREDIT for prior health coverage, Providing rights that allow individuals to enroll for coverage when they lose other health coverage or add new dependents. That, in a BRIEF nutshell is HIPAA - there's so much more involved! This and COBRA are my specialties - I live and breathe the stuff!!
   — Rosario T.

August 28, 2002
I'm sorry, I meant HEATHER!! I didn't check before submitting :-)
   — Rosario T.