How are claims for pre-existing conditions handled?
Your medical plan may contain a waiting period for expenses incurred in connection with a pre-existing condition. In general, a pre-existing condition is any illness or injury for which medical advice, diagnosis, care or treatment was recommended or received within a specified time period prior to your coverage enrollment date. Specific details on this time period and the waiting period for coverage can be found in your health plan benefits booklet or certificate of coverage. If you submit medical claims for a condition which may be pre-existing, additional information may be required from you and your provider of service. You may be asked for a list of physicians that have treated you in the past for the condition, or your provider may see a request from BPA for your medical records on the Explanation of Benefits form for the claim you submitted. It is your responsibility to make sure this information is submitted to BPA since your claim will remain in a denied status until the reques
