Question:
Can you get pre-existing clause waived if your case is medically necessary?

I have a pre-existing clause for 12 months and I am now in my 8th month of it. I have sleep apnea, hypertension,bmi of 40 and urine incontence also degenerative arthritis of the spine. If this is consider medically necessary then do you think the insurance co. can go ahead and approve for the surgery. I have my first consult with my surgeon on sept. 12. thanks for any help sherri [email protected]    — sherri P. (posted on August 12, 2001)

August 12, 2001
Hi Sherri, did you receive treatment for obesity or related conditions within six months prior to the effective date of the policy? That is what pre-existing clause refers to, treatment for a condition within that time period. So if your answer is no, then there should be no problem starting the process now. This doesn't mean however that they will automatically approve the request for WLS if medically necessary because there are other reasons for denial, but certainly it should not be because of a pre-existing clause. Hope this helps, I wish you all the best.
   — dandjon