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Pre-Existing condition Exclusion

Ok!! I am on the verge of a nervous breakdown!!! I got the "dreaded" call today that I have to wait until December 2014 to get banded. What the What! The insurance person called and said that as she was trying to finalize everything she learned that due to me being new to the policy (Dec 2013). That I have to wait a year. I did receive a certificate from my prior insurance company stating that it could be used to shorten this exclusion period. Has anyone had any experience with this. I had continuous prior coverage from 2008-2013.

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when it comes to insurance never take one person's answer to be written in stone. write a letter of appeal and cc it to your state insurance commissioner. do whatever you can to over turn their decision. and don't write to customer service. send it to the higher ups. find out who they are. I wish you luck. but a lot of insurances do have waiting periods for different things to become effective. even medicare has a 6 mos. waiting period. I wish you luck and gumption.

Is this a self-pay plan or a group plan through work?

  • Author

It's a group plan through my husbands employer

10mts seems a horribly long time to wait.. but as terry mentioned above it's not unheard off to have to wait. i've had the same insurance since 2000 and i was made to wait 5mts before surgery.. if you can't appeal the wait time i suggest you find out what all their other requirements are now.. my 4mts was because i was required to have 4 weight loss related vists that had to be 1mt apart.. and then once that was completed it took another month to get approval if this is also a requirement you can start that before your dec date. that way you are ready to go and can submit for approval rather than be surprised and have to wait again. i have seen others post they required 6mts or more. best of luck.. keep fighting this

  • Author

I can breathe now!!! Due to having continuous prior creditable health insurance coverage for at least 12 months (I had for 5 years!) my pre existing condition waiting period has been waived!!!.. I am back on board for my March 26th date!! Thank you Jesus!!!

when it comes to insurance never take one person's answer to be written in stone. write a letter of appeal and cc it to your state insurance commissioner. do whatever you can to over turn their decision. and don't write to customer service. send it to the higher ups. find out who they are. I wish you luck. but a lot of insurances do have waiting periods for different things to become effective. even medicare has a 6 mos. waiting period. I wish you luck and gumption.

I had heard the same thing for Medicaid....a six month waiting period of time, in which you would visit a Dr. monthly for obesity related causes and they would write you a "package" justifying sleeve gastrectomy. Oh, the hoops we have to jump through for insurance sometimes....

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