Re: pre-existing condition

[Guest guest]

Ok folks, now I am getting worried. I got laid off from my job last Oct. and

couldn't afford COBRA. Have been without ins. since then. Just finally got

a new job 6 weeks ago, will get new ins. in 6 more weeks. From what I have

seen on line the new ins. does cover this surgery - have seen people who have

gotten it here in OH with the ins. I am getting. I think I have found a Dr.

who will refer me (checking on that now) if I go with the PPO. I have found

a Dr. in network who does the DS. Now, do I have to worry that the ins.

company is going to say this is a pre-existing condition (my being obese -

hell, its been a lifetime existing condition!) and say they won't pay for

that reason?

Carole

[Guest guest]

In a message dated 08/08/2001 10:11:55 PM Central Daylight Time,

MsMystic1@... writes:

> . Now, do I have to worry that the ins.

> company is going to say this is a pre-existing condition (my being obese -

> hell, its been a lifetime existing condition!) and say they won't pay for

> that reason?

>

Sometimes if there is a preexisting condition clause it is in a group policy

it is for a specific period of time. for instance I know of one that would

only pay $4000 on a preexisting condition in the first year of coverage.

After that they would not consider it preexisting anymore.

Dawn

Dr. Hess, Bowling Green, OH

BPD/DS

4/27/00

www.duodenalswitch.com

267 to 165

size 22 to size 10

have made size goal

no more high blood pressure, sore feet, or dieting!

[Guest guest]

Dear Carole,

Usually, if a group policy has a pre-existing condition clause, it

will be for a short period of time. Our company's policy when we

changed plans had a pre-exisiting clause of 3 months if you didn't

have prior health insurance coverage. If you rolled over from another

plan, this clause did not apply. Every plan is different. Ask to

see a copy of the plan benefits booklet.

Good Luck

Jane J.

> Ok folks, now I am getting worried. I got laid off from my job last

Oct. and

> couldn't afford COBRA. Have been without ins. since then. Just

finally got

> a new job 6 weeks ago, will get new ins. in 6 more weeks. From

what I have

> seen on line the new ins. does cover this surgery - have seen

people who have

> gotten it here in OH with the ins. I am getting. I think I have

found a Dr.

> who will refer me (checking on that now) if I go with the PPO. I

have found

> a Dr. in network who does the DS. Now, do I have to worry that the

ins.

> company is going to say this is a pre-existing condition (my being

obese -

> hell, its been a lifetime existing condition!) and say they won't

pay for

> that reason?

> Carole

[Guest guest]

Now, do I have to worry that the ins.

> company is going to say this is a pre-existing condition (my being

obese -

> hell, its been a lifetime existing condition!) and say they won't

pay for

> that reason?

NOPE!NOPE! NOPE! If you are joining a group ins. policy thru your

employer with no physical involved prior to sign up, Legally there

ARE NO pre-existing condition clauses on a group ins. policy when/if

you sign up at open enrollment or finally meet the time criteria

Colleen - Iowa H/R dept, ACT, Inc.

DS 1-15-01

Dr. Buchwald

312/21?/160

[Guest guest]

Carole,

My understanding of the law is that there is a 12 month limit on pre-

existing condtion clauses. Not all policies have such clauses, and

some are shorter than 12 months. Some limit the $ amount of coverage

for pre-existing conditions. So you will have to look into the

policy. Even if you have to wait a full year for surgery (ugh) you

could proably do all your prep work before hand and be under the $

limit - but check your policy.

Hull

[Guest guest]

> If you are joining a group ins. policy thru your

> employer with no physical involved prior to sign up,

> Legally there > ARE NO pre-existing condition

clauses on a group ins. policy when/if you sign up at

open enrollment or finally meet the time criteria

>

I really think that the size of the group determines

if there is a preexisting condition clause.....I work

for the state now, and there is no preexisting

condition clause with any insurance plan......I was

previously employed by a smaller agency......and there

was a preexisting condition clause......for me this

meant that if there was a gap in insurance coverage at

any time during the 3 months prior to joining the new

insurance that claims would not be covered.....I had

been covered under COBRA but had missed 2 payments

because I was not employed at the time...when I went

into inpatient eating disorder treatment under the new

plan, my insurance didn't cover it......they said they

would and then decided it was preexisting.....I am

still paying on a $10,000 hospital bill from 1995.

__________________________________________________

[Guest guest]

Well, I went through some information I had sent for about different

insurance policies when I was thinking of buying it as an individual policy

(now will just wait for the ins. from my job due to get in 6 weeks) and the

same company that I will have sent me info on individual policies.

Individual policies cost WAY MORE than group and have a different set of

rules, so I doubt this will apply with the group policy, but this is what

they said:

" There is a 12-month waiting period for pre-existing conditions under the

SuperMed Classic individual coverage. (remember this is individual)

A pre-existing condition is a condition for which you incurred medical

expenses, received medical treatment, used a prescription drug or were

advised by a physician or professional provider to receive treatment during

the six months prior to your effective date. The number of months you were

enrolled under your previous coverage may apply toward the waiting period. "

It appears to me that, the only thing I would have to worry about is, in

April, I got a bad case of bronchitis, first one in about 15 yrs (3rd time in

my life, the other was about 15 yrs before that) and had to go to the Dr. to

get antibiotics for that. I would guess they wouldn't cover that, but no

biggie to me. I haven't taken any prescriptions since probably last

November, since I haven't had insurance so couldn't afford the actual cost of

prescriptions. I was taking prozac back then, but off it now the whole 6

mos. Would like to go back on, but I can wait if necessary, but I don't

think I'll have to since I haven't taken any for so long, don't think it

would be considered pre-existing.

So - I don't think obesity will be considered a pre-existing condition, if I

am reading this right - unless I had had to get treatment for some related

co-morbid, which I don't have.

Does everyone else see it this way?

Carole