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  #11  
Unread 04-08-2002, 02:18 PM
Whew! Wish I'd KNOWN that!!

Was quite calm today and things are turning out o.k.--so far, so good, but it's obviously not over yet.

The lady from the Dr's office had called Friday to let us know what the insurance company had told her when she had called them regarding the BENEFITS THEY WOULD PAY TOWARD THE HYST. She hadn't even called for pre-authorization yet. I do think I gave her some useful "ammunition" for when she does.

(They told her my doctor and hospital were not "members" or on the so-called approved list, but I told her that when I got on the insurance website Sunday, my doctor and hospital WERE listed.)

The Dr's. office lady wanted me to know that the insurance co. said there MIGHT be pre-existing conditions. HOWEVER, since I'm lucky enough to be connected with very smart ladies (thank you!!!) plus reading my insurance plan book, I know they can't deny me for that.

Here's the tricky part--and I really didn't find much on pre-existing condition in my search and maybe someone might need this some day -- IF YOUR EMPLOYER CHANGES INSURANCE COMPANIES, THEY CAN TRY TO PULL THIS PRE-EXISTING STUFF. Then something called "continuous coverage" comes into play. The "plan" says I would have to wait 18 months past the time the pre-existing condition was mentioned, HOWEVER, THIS COULD BE WAIVED. If I had "continuous coverage" with a group health insurance plan (well, duh, I've been employed by the same place for the past 11 years), THE PRE-EXISTING STUFF CAN BE REDUCED ACCORDING TO HOW LONG I WAS COVERED BEFORE. Therefore, the way I read this, I can't be denied because 10 years is a whole lot longer than 18 months.

The lady at the Dr's office said she had something else she had to do today but would be calling for pre-authorization this week. I encouraged her to do it soon since we've already got the sub booked and if there were any problems, I wanted plenty of time to straighten things out. A positive in this is I'm getting to know "Debbie" at the Dr's. office, and she seems really nice!

Hopefully, no one will ever need the info above, but maybe my experience will help someone else. The way employers change insurance companies, trying to find the best "bang for the buck", I wouldn't be surprised if there were many of them looking for new/different insurance companies.


I just KNEW you all could help me with support and information and that really made the past 24 hours bearable for me. Yep, I sure can be a worry wart sometimes!

s and
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  #12  
Unread 04-08-2002, 02:44 PM
Insurance approval questions

Jeannie --

Your "worry wartness" is not a problem. Glad you found a listening ear in the dr's office. Best of luck in getting this resolved. Let us know...

s
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