Insurance Medical Board

[jenny616 15]

Well was scheduled for surgery on Monday but got denied now my doctor has to fight for me! Goes to the review board Monday! Ugh!

[Back~To~Amy 307]

I'm sorry this happened to you. I hope you are able to get the denial overturned. Keep us posted.

[jenny616 15]

Pre existing clause sucks! Medically its necessary but the pre existing wait period over rules. My options are to wait until January or change insurance companies and see what happens...any suggestions?

[Back~To~Amy 307]

Is your insurance through your employer or individual coverage you took out? I'm in insurance so I have a bit of knowledge on this. Can you give me more details on the pre-ex denial?

[jenny616 15]

There's a wait period for pre existing conditions that's all

[Back~To~Amy 307]

Sounds like individual insurance as you shouldn't have a pre-ex clause with group insurance through your employer. If you are thinking of getting another individual policy, you will likely to be subject to another pre-ex clause. You are probably better to wait put your current coverage.

[jenny616 15]

But the doctor said if I switch I'll have been covered for at least 6 months prior and as long as I don't have a break of 31 days or more between policies that there shouldn't be a problem

[ebonisekim 1,713]

I have a pre existing clause and I'm with a group plan through my employer .. I had to wait a year ...

[Back~To~Amy 307]

I have a pre existing clause and I'm with a group plan through my employer .. I had to wait a year ...

Wow! I haven't heard of that before.

[valdostaGA 149]

My coordinator told me that in order to get approved I had to show I been obese for the past 3 or 5 years...so of course its pre existing, but as long as I haven't went to a doctor to be treated for obesity and I never have. So I'm so confused!

[jenny616 15]

The dr with the insurance said that I was good to go medically but because of the pre existing week. I have to wait which is ridiculous but he's going to write that I'm good to go medically in the denial letter so hopefully that will help me when the waiting period is over unless I switch insurance company

[Back~To~Amy 307]

My coordinator told me that in order to get approved I had to show I been obese for the past 3 or 5 years...so of course its pre existing' date=' but as long as I haven't went to a doctor to be treated for obesity and I never have. So I'm so confused![/quote']

Your situation is tricky. Do you have any comorbidites that you received treatment for such as high blood pressure, high cholesterol, sleep apnea etc. Your insurance company could say those were obesity related and thus say you had treatment for obesity this making obesity a pre existing condition. It is really gonna depend on your medical records/history and the exact wording of the pre ex clause as well as state laws in the state where the policy was issued.

[valdostaGA 149]

I'm preparing myself just in case they do say its pre existing. My 12 months will be in January and I pray I don't have to wait. As. Many times as I've called my insurance about the requirements for surgery...seem like they would have mentioned if I had a clause. And another thing..they paying for my 6 month diet visits... so I hope they approve me! I been trying to get surgery 2 years and my hair is turning gray from worrying about(seroius) i m up all times of the night can't even sleep some nites.