Question:
Denied my short-term disability coverage.

Star Administratice Services has denied my income replacement for my WLS and gall bladder surgery 6 months ago. I have gone around and around with Star--they say that my health issues were preexisting even though I have never been diagnosed or treated for gall bladder disease. They insist that I was, in fact, treated for gall bladder disease but they refuse to provide the documentation they say they have proving their case. I did not know I was having gall bladder surgery until one week prior to surgery, and they only reason I had it removed was because I asked my surgeon to take it out due to a high number of family members who have had the surgery before the age of 35! Whew! Anyway, I can't find an appeal letter for this situation. Anyone have any ideas?    — jenn2002 (posted on October 19, 2002)

October 19, 2002
It sounds like maybe they are saying your WLS diagnosis was pre existing. If the Insurance Pre certed your surgery,they are usually saying they consider it medically necessary.But,it is still dependent on your benefits.If you have a pre existing clause they can still deny the charges..If they paid for your surgery and not your short term disability this is a conflict.But, be careful because they could go back and request a refund on the surgery payments!!! I work for an Insurance Co and have seen this happen. You are right though they should have to prove it to you. If you had any other insurance before this Ins.and it was in effect up to the date you took this insurance,I think there is a law that says they have to accept your "Proof of Insurance" from the previous Co to meet your Pre existing waiting period. Hope it works out for you. Nancy Poe
   — NANCY P.