Pre-existing condition? Oxford Insurance.

[OneFineDay 0]

Hi All!

Sooooo bummed out right now. Long story short I got all my paperwork together... letters, signatures, psych evaluation and things have almost seemed TOO GOOD TO BE TRUE! The woman at my doctor's office even told me today that I will probably be able to have the surgery by mid-July...

... until she submitted the paperwork today and Oxford came back telling her I have a pre-existing condition. Gee. Ya think? I certainly didn't get this BMI of 42 over night.

Anyway... has anyone dealt with this? My insurance is fairly new, as I started a new job in December and had Aetna as my provider previously. This is the first time I have submitted anything for WLS ever.

Any feedback would be much appreciated! And prayers. Prayers, too!

xo:crying:

[mandi78 3]

Did you have a lapse in coverage between Aetna and Oxford? If not, by law, they cannot exclude pre-existing conditions (which your weight would be). If you did not have a lapse in coverage, you can get a letter from Aetna (I think it's called proof of prior coverage) and that should be sufficient. This is a law called HIPAA, the Health Insurance Portability and Accountability Act. Check out this link.

Questions and Answers About Health Insurance (continued)

Don't let them screw you around because they will try if they think you don't know better. Let them know that you know the law. Check with the insurance person at your doctor's office about this. Good luck.

Edited June 13, 2008 by mandi78

[amsderb 1]

Good Luck I am glad Mandy had an answer!

[LindaLouRN 0]

Mandi is correct. If you had health insurance coverage for the past 12 months and your lapse in coverage when you changed from Aetna to Oxford was less than 63 days - you do not have a pre-existing condition and they have to cover it just as they would for any other participant. Even if you changed insurance companies more than once in the past 12 months - as long as your lapse between coverage was less than 63 consecutive days each time you changed you are covered. I have dealt with insurance jerks more times than I care to count when it comes to pre-existing conditions, but stand your ground and don't let them push you around, because they will do everything they can to not have to pay.

Your previous health insurance company should have sent you a letter proving previous coverage. You probably would have gotten this letter with your cobra offer/information. If you did not pay for the cobra coverage - no big deal - just remember less than 63 days. Fax or mail a copy of the proof of previous coverage to your new insurance company.

Stay strong and don't let the insurance company win!

[OneFineDay 0]

Thank you so much for the info, Mandy. I had a 90 lapse between the two companies, so it looks like I am screwed.

Grrrr.

This helps a lot, though.

[mandi78 3]

I know, it sucks that new places of employment make you wait 90 days before you can get coverage. I'm dealing with the same thing right now and the company I'm leaving does not even offer COBRA (which I thought was a mandatory law) so I'm screwed too on my pre-existing conditions.