Question:
If insurance tells you you are approved for wls but have to schedule?

in Aug. b/c they are still telling me somewhere in my Dr. notes that a Dr. I seen said they seen me before the look back period even though the rep. called and verified himself that I did not see anyone before look back period and when I called today he said I was approved but for Aug. 1,2003 so he said I can schedule to have the surgery on that date,but then he told me he dont understand because he put in with my file to medical review that the pre-existing should be lifted b/c he verified that I didnt have pre existing anyway he talked back with the medical review and they said it doent matter that even if it was a mistake that a Dr. put in that he seen me in look back period that they I still have to wait I spoke w/ another lady there and she is going to try to find out what is going on for me and try to get the approval for todays date insted of Aug.1. I am sorry so long but I want to know if this lady cant get me to have a sooner date for approval and the approval letter says Aug.1 2003 and lets say my husbands is up for renewel on that date and they dont pick the sam insurance does bcbs cover me on Aug.1,2003 for the surgery?    — marie M. (posted on May 28, 2003)

May 27, 2003
Sounds like to me they are making you wait because of what they are calling a pre-existing condition. Usually that is 1 year from the existing Dr. visit. Keep fighting it, maybe go back to the Dr. and ask if he can send a letter supporting the possible mistake. Good Luck!
   — Barbara S.

May 27, 2003
I can't answer about the date and the look back period. The only thing is if this policy is through your husband's employer and the company just made a switch and you were never without insurance then I believe BCBS has to accept all pre-existing conditions and provide coverage from day 1. I have never heard of a company changing coverage and pre-existing conditions coming into play. The only difference would be if your husband changed jobs, then the pre-existing might be able to come into play although as long as you did not go more than 2 months without coverage you should have been considered insurable. I would keep pushing with BCBS. <p>As far as waiting till August 1st, if your husbands insurance changes effective Aug 1st then the approval from BCBS doesn't mean anything as they will no longer be the current insurance. Also it is possible that even if the company stays with BCBS there is no guarantee it will be exactly the same policy and that it will cover WLS. I know that isn't what you want to hear but it's better to know the reality than live with a misunderstanding. <p>I suggest you talk with the HR department where your husband works and find out about the pre-existing conditions etc and whether when they changed if it was there understanding that pre-existing conditions would be an issue. Also the fact that verification has been made that you did not see someone for this before. Your best chance right now might be to work with HR and see if they can't help you get it before Aug 1st. It sounds like you qualify so timing is the only issue. Good Luck!!
   — zoedogcbr