Worried that my insurance benefits are going to change during open enrollment in NOV!

[Valerieee 0]

I never even thought this would even be a possibility.

I went in for the seminar, and scheduled my first apt to kick off my 6 month pre op. The lady that was helping me said "Make sure you check with your HR and see if your benefits are going to change with the new year coming up. We had a lady who finished her supervised diet, and come to find out, her insurance no longer covered the lap band surgery this year."

my heart dropped. I really hope this isn't going to be a problem. I called to find out, and apparently they won't know until our open enrollment On November 15. So I will be in the dark for over a month.

Just something else to stress about, I suppose.

Has this ever happend to you or anyone you know?

[ardelia 41]

Same thing here...

I just found out on Friday that the HMO I have had for years will no longer be an option. The PPO that will be an option will NOT cover surgery with the surgeon I have been seeing. They only use Centers of Excellence.

If I don't get surgery before the end of this year, I'll have to start over again. Of course, I don't even know if my employer's specific plan with the new PPO will even cover bariatric surgery. Ugh.

:smile2:

[ardelia 41]

I never even thought this would even be a possibility.

I went in for the seminar, and scheduled my first apt to kick off my 6 month pre op. The lady that was helping me said "Make sure you check with your HR and see if your benefits are going to change with the new year coming up. We had a lady who finished her supervised diet, and come to find out, her insurance no longer covered the LAP-BAND® surgery this year."

my heart dropped. I really hope this isn't going to be a problem. I called to find out, and apparently they won't know until our open enrollment On November 15. So I will be in the dark for over a month.

Just something else to stress about, I suppose.

Has this ever happend to you or anyone you know?

I know I already replied, but I just wanted to address one more thing. You have to wait longer than I do to ask questions. I "only" have to wait till the 22nd of October and then I can ask questions. :smile2:

[Valerieee 0]

What a pain in the behind. Nothing can ever go smooth, There always has to be something.

But good luck, and I really hope you are able to get taken care of before the year is over. Keep in touch!

[ardelia 41]

What a pain in the behind. Nothing can ever go smooth, There always has to be something.

But good luck, and I really hope you are able to get taken care of before the year is over. Keep in touch!

Nothing good comes easy, right? Okay, not necessarily, but I keep telling myself that to make me feel better. :smile2:

I'll cross my fingers that you, too, are able to get your surgery!!!

[bayareanan 24]

Mined happened the other way. I had gone through my 6 mo diet only to find out bariatric procedures werent covered. But, this year we switched carriers and they are.

I had to wait a year longer than I had planned, but it worked out ok.

[Twinkles 7]

This happened to me and I was DEVASTATED!!!

I originally went through this whole process in 2007. I started my 6 month diet in August 2007. Well, wouldn't you know, our benefits plan changed and effective Jan 2008, surgery was no longer covered. One freaking month! January would have been the end of my 6 month diet. I just couldn't believe it. I had already had my psych eval, all the medical tests done, everything.

I contemplated self pay, procrastinated a few years, then 2010, the plan changes again and it is again covered. I jumped on that as soon as I found out in February. FINALLY, after 3 years, I was banded July 2010.

I hope your plan stays status quo!!! Good luck!

[BetsyB 9]

I was concerned about the same thing last year. (My surgery was just after the new year.) Your HR people should be able to give you the information you need.

I was reassured that there would be no changes to coverage, but that since I'd started the process already, even if there were changes, I would get the coverage that was in effect when I was pre-approved. (Each policy is different, but mine gives preapproval at the very beginning of the process; then, if you jump through all the hoops and get clearance from the right guys, it's pretty much green-lighted.)

Try to get some peace of mind from the people who manage your benefits

[ardelia 41]

I was concerned about the same thing last year. (My surgery was just after the new year.) Your HR people should be able to give you the information you need.

I was reassured that there would be no changes to coverage, but that since I'd started the process already, even if there were changes, I would get the coverage that was in effect when I was pre-approved. (Each policy is different, but mine gives preapproval at the very beginning of the process; then, if you jump through all the hoops and get clearance from the right guys, it's pretty much green-lighted.)

Try to get some peace of mind from the people who manage your benefits :mad2:

Trust me, with a company as large as the one I work for, there is no way to actually speak to someone from HR. There is a generic "help" line that covers everything from computer issues to HR to retirement. Oh, if you call during certain hours, forget it. Just hang up. Actually, in my experience, I only get actual HELP approximately 10-15% of the time. NO, this is not an exaggeration.

It surely would be nice if the company would honor anything already started toward a specific procedure (such as bariatric surgery or - really - anything else. Of course, that would be a total nightmare for the company, but it would surely help out the employees. Oh yeah, THAT is why they wouldn't do it. God forbid that the employees get help.

The name "human resources" (at least where I work) is quite inaccurate. It should be called COMPANY RESOURCES because it is difficult to get any help from our HR department. :thumbup::smile2::wink2:

[arittel 0]

Something very similar happened to me...January 1, 2010 began the new calendar year for our Health insurance through my husbands employer. They did NOT have any pre qualifiers other than a BMI over 36. So January 7th I met with the surgeon, they filed the paperwork and I was approved by the 14th. Only to find out that we couldn't do the surgery until February 2010. No big deal right. EXCEPT on January 25th my husbands employer sends home a letter that states effective February 1, 2010 they will be switching health insurance providers.

So the surgeon re-filed with the new company and what do you know --you have to do the 6 month weigh loss program. (So I joined Weight Watchers because that was one of their approved programs.) Well 3 months into this I find out that because our Weight Watchers team leader is NOT a certified dietician it doesn't count. I have to do a program through the dr.'s office. Well luckily I had been going to the doctor monthly anyway for various items, thyroid checks and what not, that he had monthly weights on file. I kept going to weight watchers also. SO I had 6 months of a program PLUS the dr's visits. Sent it in and was approved in less than a week . I hope everything works out for you and that they don't change benefits. Getting Banded October 13th and refuse to believe it will really happen until I wake up from the surgery and am told it is DONE

[honk 780]

Hi. I have worked in HR at large companies (UBER large). You can get someone in benefits. If you have to go to LinkedIn run a search for someone at your company in Employee Benefits and get a name. Go to your companies phone list and CALL them. These people exist and you have a right to speak with them. Trust me they know what is going to be covered in any insurance changes NOW. As a company you are a community, and believe it or not a team. No one in benefits wants to get a call from their boss saying people are complaining that his team are'nt being responsive to their "customers" (that would be you.)

[BetsyB 9]

How frustrating! It sounds like Honk's ideas are really helpful. I hope you are able to get good reassurance.

[Angera 2]

I can absolutely relate to this. However, in my case, I was on the tail end of my 6 months and the e-mail had gone out in month 5 about lapband coming with a $5000 deductible plus %20. I could've died. HR even said the WOULD NOT grandfather folks who were close to surgery, JERKS!

I was able to work with the doctor and insurance to have my paperwork submitted one month early to assure my surgery date fell before aug 31, which was my change of fiscal year and benefits.......

Try everything, I called the insurance over and over and over until someone finally said well just submit your paperwork and see what happens...........the nutritionist and doctor were willing to do it because of the circumstances and i was sooooooooo close to the end!

So it's quite stressful, I KNOW! But put up a fight, I did, and it payed off