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N Cal Attorney
N Cal Attorney, Attorney
Category: Consumer Protection Law
Satisfied Customers: 9394
Experience:  since 1983
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I changed my insurance policy from State of FL Blue Cross/Blue

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I changed my insurance policy from State of FL Blue Cross/Blue Shield to AL BCBS in January 2013. My son (adult child in college covered on the policy) needs open heart surgery from a heart defect he has had since birth and has been fully disclosed. BCBS AL says this surgery is not covered due to it being a preexisting condition. I have not had a lapse in coverage and I believe HIPAA covers me from this exemption. The insurance company is being very combative and insists the pre-existing condition applies even though there was not a lapse in coverage.

Please help me get this surgery approved.
I am sorry to hear this.

You need a local attorney to review the policy and all correspondence to and from the insurer.

Starting in 2014, discriminating against anyone with a pre-existing condition will be illegal, see
but it is not per se illegal yet. The denial of coverage may or may not be legal, but it depends on the terms of the policy, which I cannot read from here.

You can get a free consultation from some of the attorneys listed by location at

If the denial of coverage is made in bad faith, the insured can recover punitive damages in addition to the damages for breach of the insurance contract, see

Only a local attorney can provide legal advice. Please follow up on this with a local attorney, who can review the documents and advise you on how to proceed. Sometimes a demand letter from an attorney is enough to get an insurer to reverse a denial of coverage. Sometimes, a lawsuit is necessary.

I hope this information is helpful.
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