Company changed insurance question

[Mellie 0]

I was wondering if anyone has had this problem or any advice for me.

I had the lap band surgery in June of 07. My company insurance was BCBS of NC at that time and they covered surgery and follow ups, fills etc. Later that year, my company went self insured thru med cost. At that time the HR department told me nothing would be covered related to weight loss or my follow ups. Because of this I have not been able to have regular follow ups and maintenance. I only go when I can save enough to.

I spoke with our HR again, but she was no help and I also spoke with a company nurse and she said that she believes this is wrong. Because I did not change insurances and I have a medical device in me they should not deny me care now.

I need to know if anyone else has dealt with this and if there might be any options I could take. Thanks so much!

[Sue Magoo 71]

Mellie:

Have you considered talking to your lapband doctor about this? Perhaps he/she can give you a discount for your follow-ups because you will have to pay cash. It's worth a shot. If you're not comfortable asking this in person, why not send him/her a note asking them about possible discounts.

It's very unfortunate that these things happen. I was laid off in April and my new COBRA plan stinks. I haven't had any fills or unfills since switching to my COBRA plan. Thank goodness I have pretty much maintained without any adjustments.

Best wishes to you.

Sue

[ParrotheadCathy 0]

Talk to the insurance commissioner's office for your state. There may be regulations about reductions in what is covered, especially in your situation since you were originally covered but now are not.....

[Mellie 0]

I have talked to my doctor's office about this and they do give me a discount if I pay in cash at the time of my visit. That does help some, but it's still alot out of my pocket, especially for fills.

[TinaM 0]

Mellie-

In addition to contacting the insurance commissioner in your state, I would contact a health advocate. There are several out there just do a web search.

We use this agency thru my employer - I'm sure they can give you some advice or direct you appropriately(Health Advocate 1-866-8622, answers@healthadvocate.com)

Also, if your employer offers EAP services (Employee Assistance Program) there should be something there to help you advocate as well, just call the EAP number and explain the situation.

Tina

[Mellie 0]

Tina,

Thanks a bunch!! I will definately try that. I'm going to give them a call.