Question:
Starting my work-up Before my new ins coverage begins??

I have decided to go with my husbands PPO provider for my ins as well. And then drop mine, since it lists in it's exclusions NO weight loss surgery of any kind for any reason. I can find no such exclusion in the information that we were given on his PPO plan. They do however state that they have No pre-existing condition clauses in their policy. I had called their customer service # to see if an RNY would be covered if medically necessary and they said no it would not. However I'm going to try and get it through them anyway since my coverage said they won't in writing in their exclusions. My question is this....I have an appt with a surgeon Dec 2nd and I would like to keep that and start my work ups now. I realize that I will have to pay out of pocket for the appts and tests now because the ins coverage doesn't take effect until Jan 1 2000. But I hate to wait until then to get everything started. Then I could just have it submitted after the 1st of Jan for the surgery. Do you think that it would cause any problems with being approved for the surgery? Because I started my work-ups before coverage began? I don't want to cause myself anymore problems getting approval then I will already have. thanks, Deb C    — Deb C. (posted on November 4, 1999)

November 3, 1999
Hello Deb. I know you want this to go fast for you but if you go to the doctor before your insurance get started you have put up a wall that you will not be able to get down with the insurance co. Then they can call it pre-existing.I worked in insurance before I quit work. I repeat no not go for this or anything that is about your obesity problem until your insurance is in effect. GOOD LUCK!!!!!!!!
   — Patricia B.

November 3, 1999
Hi there....It is my understanding that according to a federal law regarding insurance companies and pre-existing conditions, if you are switching from one group insurance company to another (both being offered by your or your spouses employer) the pre-existing conditions rules DO NOT apply. Pre-existing conditions only come into effect if you currently don't have ANY insurance coverage at all and are joining a group policy through your employer, or are joining a private policy that you have chosen. The way I understand it is that if you are switching from one group policy to another, the new policy has to act like you have been covered by them during the time you had coverage under your old group policy. I don't think you have anything to worry about, but the very BEST way that you can find out is to call the information number on the new insurance and find out if there is a pre-existing conditions clause if you are SWITCHING to them from another group policy. Good luck!
   — [Anonymous]

November 4, 1999
I may not be understanding what you are saying very well but if you have two insurances(yours and your husbands) and you are changing your primary insurance to the same one as your husbands then you have nothing to worry about. Are you on your husband's policy? There is a law called the HIPPA (something like that) law that requires insurance companies to waive the pre-existing clause if there is prior coverage for a length of 6 months or it may be 12 months. Just try to make sure there isn't a break in your insurance coverage. Good luck.
   — SherP