Anyone have PRE-EXISTING CONDITION insurance complicatoins?

[Guest guest]

I wasn't too worried about getting insurance approval, based on my

surgeon's telling me that I shouldn't have anything to worry about

regarding medical necessity, etc.

But now I'm starting to worry, because my insurance company has

launched an investigation into an UNRELATED claim I made for another

minor surgery I had in late December. Apparently, since I had only

had

coverage with them since November 1st, it raised a red flag when I

submitted a moderate-sized claim just 2 months in.

So it seems as though they're real sticklers for the 'pre-existing

condition' thing. Is it possible that they'll look at my ortho pre-

authorization claim I plan on submitting this summer for my August

surgery and refuse to cover it based on an argument that it was a

'pre-

existing condition'. While it's true that a few general dentists I

have seen had previously commented on my open bite and thrown out the

idea that ortho would fix it, I had never really considered the

surgery

seriously until I switched to my current (much better) health

coverage.

[Guest guest]

Who knows what any insurance company will do? It's still a mystery

to most of us. All that I can think to tell you is to make sure you

check your member handbook to find out how long your pre-existing

condition exclusion is, it doesn't last forever. Usually it is 6

months or 1 year, depending on your insurance. Worst case scenario,

you have to convince your OS and ortho to wait until November to do

your surgery once your exclusion period ends. Let us know what

happens.

Connie

>

> I wasn't too worried about getting insurance approval, based on my

> surgeon's telling me that I shouldn't have anything to worry about

> regarding medical necessity, etc.

>

> But now I'm starting to worry, because my insurance company has

> launched an investigation into an UNRELATED claim I made for

another

> minor surgery I had in late December. Apparently, since I had only

> had

> coverage with them since November 1st, it raised a red flag when I

> submitted a moderate-sized claim just 2 months in.

>

> So it seems as though they're real sticklers for the 'pre-existing

> condition' thing. Is it possible that they'll look at my ortho

pre-

> authorization claim I plan on submitting this summer for my August

> surgery and refuse to cover it based on an argument that it was a

> 'pre-

> existing condition'. While it's true that a few general dentists

I

> have seen had previously commented on my open bite and thrown out

the

> idea that ortho would fix it, I had never really considered the

> surgery

> seriously until I switched to my current (much better) health

> coverage.