Question:
Why do I have to wait the 6 months? BCBS of NY

I understand that if you have a lapse in insurance prior to your existing insurance, which I DID, they can get ya for the pre-exisiiting clause. HOWEVER, I thought you had to be TREATED for the illness/disease etc. in the 6 months prior to your new policy. I had a lapse yes, but I was NEVER treated for obesity in my life. DO this still apply to me???? HELP!!!    — lyssann214 (posted on October 30, 2003)

October 29, 2003
That's my understanding also but I suppose it is difficult to say you have never discussed your weight with a doctor before. I'd be asking the question to the insurance company. However, this could be a double edged sword. If you say you have NEVER gotten treatment and then they come back and say they need a doctor supervised diet attempt then you have cooked yourself. I would ask for their requirements for approval before I said too much. I know when I got my approval with BCBS of WI they did not mention needing a doctor supervised diet, but they did ask for a detailed diet history, which I did do Redux and Xenical. Ask for questions but tread lightly. If they do require the doctor supervised diet then take the 6 months to meet that requirement so you don't run into another delay.
   — zoedogcbr

October 29, 2003
Pre-existing condition limitations are generally structured so that if you have been treated (including prescription drugs), or sought medical advice about a condition in the 12 months before the coverage began, then the condition is not covered for six months after the policy goes into effect. This provision is applied very broadly. If you have sought any medical advice for either the direct diagnosis (obesity) or any comorbidity (high blood pressure, sleep apnea, diabetes, back aches, joint aches, etc.), or if you have taken any prescription medications for any comorbid conditions, then the exclusion would apply as the comorbidities are conditions directly related to the obesity. And, the previous poster is right--you don't want it on record that you have never sought advice about your obesity, and you do not want to allege that any comorbidities are not related to the obesity. Then you'll never get the surgery covered. Do find out what the requirements are. The insurance company may very well require a six month supervised diet anyway. So, you can get started on that while you're waiting for the pre-x limitation to run out. Best wishes.
   — Vespa R.

October 30, 2003
I had the pre existing problem with BCBS of FL, but I had been treated so that was why it was pre existing. Now that that time period is up they want proof of a 6 months physician managed weight loss program...so I am trying to jump through those hoops now...plus they want a weight for 5 years prior to this time from a physician...don't they understand we just want to be healthy like normal people?
   — Fancy

October 30, 2003
If you have ever had obesity documented on your medical chart within th epast 5 years, BCBS will probably says it's preexisting. Even if it was not treated, it would have been diagnosed.
   — catleth