My step-daughter has been diagnosed with a bad gallbladder, needing surgery. She currently has Blue Cross insurance. She will have the policy for one year in May 2007. They say this is pre-existing because she has been to the emergency room for this in the past. Her previous diagnose was Sicklic vomiting syndrome. The insurance co is saying pay 11,000 to the current doctor if we want surgery now, or wait until May 2007. What can we do?

We are assuming that if Blue Cross is placing a 12 month pre-existing condition exclusion on the gallbladder condition, they have the legal right to do so. However, they are circumstances in which an insurance company must waive this exclusion period. If you can answer a few questions, it will help us determine if the exclusion is justified.

1) In which state does your step-daughter reside?

2) Is her Blue Cross policy an individual health plan or an employer sponsored group plan?

3) If it is an individual policy, did she disclose the Sicklic vomiting syndrome on her application?

4) Did she have other health insurance within 60 days of obtaining the Blue Cross coverage in May 2006? If so, how long did she have this prior coverage?

5) Is the $11,000 fee all of the charges for the surgery, or has Blue Cross agreed to pay a portion of it?

3 Comments

1. My son was just informed he had skin cancer. He did not have insurance at the time.

   He will need insurance to have this taken care of. He applied for insurance and the insurance agent had him pay and was told they would take him. Weeks went by and they did not call or let him know nothing. He called yesterday to find out why. He was denied coverage.

   Please help me out because it was just 1st stage but, the problem now is Health insurance needed badly.

   Thank You,

   Marion

   Comment by Marion — April 10, 2009 @ 8:32 am

2. Can pregnancy be counted as a pre existing condition if you didn’t know at the time and only found out later? If my doctor told me the news that I am pregnant and also that it was conceived prior to buying health insurance, will it still be seen as being a pre existing condition? I know that if you are pregnant and you know it, then you can not get health insurance right? I had a job with health insurance the last year but I quit and now I have no insurance. I live in New Jersey so I would want NJ health insurance. How far along do you have to be when you buy health insurance to be allowed in or not? I couldn’t find any information online. Thanks!

   Comment by Linda — June 21, 2009 @ 11:09 am

3. Hi, is there any hope for someone who has Crohn’s diesease and don’t have group health medical insurance? I live in the state of New York and has suffered from this disease for years. It’s not life threatening or anything, but it is very annoying and I need to take a lot of medicine to ease the symptoms. I feel like there is no help to get from anyone and it’s very difficult to figure out what is available to someone like me. I don’t make a lot of money, so it’s really expensive for me to go to the doctor and pay on my own. Could you help me find a program to pay for my medicine and trips to the doctor? I am trying to find a better job, so I can get group health medical insurance, but so far no luck.

   Comment by Tammy — June 25, 2009 @ 12:23 am

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