pre-exhisting conditions on insurance

[Stacy]

I'm an 26 yrs. of age, with cleft lip and palate. My problem
is insurance. My cleft is considered a pre-exhisting condition
and I would have to wait 18 months to even see if they might
cover any surgeries. I now there is no way around this. I have
had the repairs and bone graft, and some slight touch up work at
age 16. I am now considering maxillofacial and the abbe flap lip
surgery. First I was told that my insurance may not even cover
this when the time comes if it's not proven medically needed. Is
there any type of organization or tricks of the trade that can
help me to pay for this? Has anyone had a similar experiance as
an adult? Can anyone please help? Please e-mail me at
eads@caves.net Thank you, Stacy

[thePaganinis@msn.com]

If you live in California a state law was recently passed that
does not allow HMOs to deny claims regarding cleft lip/palate. We
are currently placing an appeal to our HMO so my husband can be
seen by a cranio-facial team. We are attempting to find
professional journal articles & other information that
advocate the team approach. You could do the same for your
situation, perhaps. And if you have a working relationship with
your primary care physician you may ask him/her how to word an
appeal letter.

[Anonymous]

Hi Stacy, Insurance will cover cleft-related surgery. I've had
four surgeries in the last 3 years and I am almost 35 years old.
It will take some advocacy on you and your plastic surgeons'
parts.



Kristi

[Kristi]

Hi Stacy, Once you get past your waiting period, your
insurance company should cover any surgery related to your cleft.
It MIGHT take some advocacy on your part as well as the plastic
surgeon's part. BTDT. BTW, Iam almost 35 and have had four
reconstructive surgeries done in the last three years.



Kristi