Question:
Has anyone heard of there being a waiting period to have the Gastric Bypass?

I have Beech Street as my provider but Drake Admin is the one who deals with the claims. I spoke with them and was told that there was a 12month "Waiting" period for pre-existing conditions such as Gastric Bypass(RNY). I am very concerned about this. I have been trying to contact people and ask if anyone has ran into this type of problem. I spoke with my Dr. and they told me that's when my letter comes in, but that doesn't make me feel very confident. I will just die if I have to wait another year to have this surgery. I have all the information that I was suppose to have, and my Dr. has sent everything to them and now they are saying they will not cover a pre-existing condition after 12months. I'm so upset!! Can someone please ease my mind??    — Tanya D. (posted on October 25, 2000)

October 25, 2000
If this is a new insurance company for you and you were diagnosed before as being morbidly obese then some insurance companies will require you to wait a year. This falls under the pre-existing condition. Now if this is a new insurance co. for you but you were switching from another insurance carrier without there being any laps in coverage, then the pre-existing condition clause should not apply. Keep in mind that there are usually those 2 stipulations to put the pre-existing condition clause into effect. So if you were not diagnosed by a physician prior to you trying to get approval with this insurance co & you have had contiuous coverage before having insurance plan there should be no reason that they should make you wait a year for your surgery. I hope I didnt make this too complicated. If you have any questions please feel free to email me at [email protected]. I wish you the best of luck :)
   — Tanya P.

October 25, 2000
How long have you been with this insurance company? And, did you have health insurance with this, or any other insurance company before this policy took effect? There is a federal law that controls whether the insurance company can make you wait 12 months. If you have been completely un-insured for the past 12 months, then they can do this to you, otherwise, check out the Federal law called HIPAA. http://www.dol.gov/dol/pwba/public/pubs/hippa.pdf This will reduce or eliminate the waiting period that they are allowed to impose on you. Good Luck!
   — Lynn K.