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Pre-existing condition, not!
May 17, 2006

Hello, I was recently tested positive and diagnosed with Acute Retroviral Syndrome. I had begun insurance coverage with Blue Cross over 6 months before and had paid my premiums faithfully and fully. I began seeing a primary care physician and had two negative HIV tests prior to the ARS diagnosis. I had noticed fevers and some symptoms and had gone to the doctor and recommended she test me for Viral Load (I'm a health care professional). She ran RNA and another Elisa and the elisa came back negative but the RNA indicated I had HIV. This indicated that I had an Acute HIV infection. She then referred me to a specialist and now my Blue Cross is denying claims right and left. They are paying for my medications but not for any labs or physician visits. I checked my policy and there is a 12 month waiting period for "pre-existing conditions". Is this something I can fight? I did not have insurance for almost 2 years preceding this policy. I have lab work that proves this is not a pre-existing condition. Thanks for any information about this situation.


Response from Ms. Franzoi

You should review the pre-exisitng condition language in your policy carefully. In some policies, in addition to language that refers to any condition you saw a physician for, took medication for, etc., it might state or a condition for which a reasonable person would've seen a physician. Based on your information that you saw a physician for fevers, etc. and your physician ran tests, even though they came back negative, this might be the basis for their actions. However, you might want to discuss this with an attorney or a legal aid group to see if you have any options. A lot depends on the actual policy language and your dates of medical care from a physician.

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