Question:
BC/BS denied me until April because of pre-existing exclusion

My contract reads pre-existing condition is anything for which you have been treated for six months preceding the contract date. I do not recall being treated for obesity (mainly becuase they wouldn't cover it in the first place) Has anyone had any exerience with this or any tips for my appeal?    — Mary D. (posted on October 3, 2003)

October 3, 2003
I think BC/BS finds anyway possible to deny coverage on this particular issue. I am now on my second predetermination and praying for the best. I have now put it in God's hands. When I got my 1st denial letter I appealed and finally got 7 appeals in before they said that they would not discuss this one any further. That I would have to have surgeon send in another one if he felt that strongly about it. My BMI is now 38.4 but I have a long list of comorbites. Good luck to you. Don't give up.
   — CINDY D.

October 3, 2003
The term "treated for" has a very broad meaning in insurance language. It means anything that you've sought professional medical advice about, or taken prescription medication for. In this case, they may be defining "obesity" broadly and including all comorbidities in the definition, so if you've seen a doctor about high blood pressure, or diabetes, or a sore back, etc., or taken any prescription meds for any of these conditions in the past six months, they consider that pre-existing. I wouldn't sweat it too much. April is not that far away. It gives you some time to get in better physical shape to have the surgery (your recovery will be so much easier if you're in the best health you can be going in). Hang in there a few more months, and go back for approval again.
   — Vespa R.

October 3, 2003
Oh Mary -- have you heard the even WORSE news?? After Nov. 1, 2003 you will have to have THREE YEARS of doctor supervised weight loss diet program before BCBS will CONSIDER approving you. I'd try to fight this with everything I had to get the surgery prior to Nov. 1st, if you don't have the three years already in... Good Luck
   — Sharon m. B.

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