insurance question...HELP!!

[morgandonor 0]

so i have all of this paperwork to fill out before the seminar on Jan 22nd. ive got the base of it finished, the last two pages are 30 questions for my insurance company representative.

the first question is do i have benefits for weight loss surgery for morbid obesity if medically necessary? then, i choose yes or no. if yes, i am suppose to complete all 30 questions...if no, i need to ask the rep to read the exclusion to me, then it says if i have an exclusion in my policy, would i self pay for surgery, and i cant. and if i say no, i dont even go to the seminar, it just ends there.

ive emailed a rep and all it said, point blank, is your plan does not cover obesity related surgeries. so is that it? its just over? I dont understand. i thought going to the seminar would help me through all of this. and i thought if it isnt included in my plan i can "challenge" it? am i wrong?

[camille01 2]

so i have all of this paperwork to fill out before the seminar on Jan 22nd. ive got the base of it finished, the last two pages are 30 questions for my insurance company representative.

the first question is do i have benefits for weight loss surgery for morbid obesity if medically necessary? then, i choose yes or no. if yes, i am suppose to complete all 30 questions...if no, i need to ask the rep to read the exclusion to me, then it says if i have an exclusion in my policy, would i self pay for surgery, and i cant. and if i say no, i dont even go to the seminar, it just ends there.

ive emailed a rep and all it said, point blank, is your plan does not cover obesity related surgeries. so is that it? its just over? I dont understand. i thought going to the seminar would help me through all of this. and i thought if it isnt included in my plan i can "challenge" it? am i wrong?

Hi there,I just hope that I dont confuse you any more but I went to the siminar and thats where I picket up a packet of information,you are confusing yourself,if I was you I would call the hospital and ask the cordinator for the surgerys and ask her or him personally, Do you already have your surgeon picked out if so you need to go to the siminar and they give you some info to fill out and then you take it from there,(where did you get your papers at or your questionaire at? until you actually talked to the cordinator and got your packet from her I really wouldnt worry about it until you go to the siminar,,,they are there to answer questions for you so if you are sutck about that Just wait.....I contacted my insurance and had them to email me and tell me if my insurance covered the surgery,and of course they did and I took it to the canceltation with me and the girl told me that they did there own legg work and get there own approvel but I tell you she kept my coppy of the approvel letter that I took in...I thought that was crazy and she kept it anyway....best of luck sweetie and I hope everything goes well...camille01

[dFaults 1]

Make sure you ask your insurance rep lots of questions, is surgery covered, is the surgeon in the newtwork, the hospital where it's being done. As I have heard before, no isn't the final answer. Most of the time it has to be medically necessary. I know mine doesn't cover cosmetic surgeries, only medically necessary. So just make sure you ask lots of questions. And ask the surgeons office as well what their policy is as far as appealing on your behalf.. good luck!

[morgandonor 0]

the paper work i am filling out that i mention above is the paperwork the hospital sent me to fill out to bring with me to the seminar. thats why im confused, why wont they help me? and why cant i even go to the seminar if my insurance says they dont approve surgery and i wont self pay? i thought there were greivances and such i could submit to get around this.

[mattie7632 24]

No IS THE FINAL ANSWER if the surgery is not a covered benefit. Do not be confused with APPROVAL. That is a different matter. All surgeries need approval and that can certainly be challenged. You can not challenge getting something covered that is not a covered benefit on your policy. That would be like trying to get your auto insurance to fix your car when you only have liability coverage. Same difference.

[morgandonor 0]

is it even worth talking to my HR dept about it? im curious about getting an individual insurance plan that isnt through my workplace. but i remember a year ago it was a fortune due to my weight, but it's sounding worth it to me. im also a part-time college student so im wondering if i could get re-added to a parents plan and try for that. im so beyond frustrated.

[mattie7632 24]

Insurance is tricky. You should be sure first off that the rep didn't give you misinformation, or perhaps the benefit changed on Jan 1? They make mistakes a lot (I own a medical billing service so I deal with their crap every day) so maybe ask twice. Definitely ask the HR rep too because if it is a benefit, you are paying for it and therefore should be able to have it done. Good luck, I hope it is covered!

is it even worth talking to my HR dept about it? im curious about getting an individual insurance plan that isnt through my workplace. but i remember a year ago it was a fortune due to my weight, but it's sounding worth it to me. im also a part-time college student so im wondering if i could get re-added to a parents plan and try for that. im so beyond frustrated.

[peacequeen 434]

I signed up for the seminar online. The registration form asked if I had insurance but didn't ask anything beyond that. I downloaded the "other" forms and filled them out to take to the seminar but didn't have to, it stated they handed them out the night of the seminar and anyone could fill them out there or take them home to fill out if they wanted to. I turned mine in after the seminar was over. When I went to my seminar, they discussed self pay. I know you said you couldn't self pay but if you are considering paying high dollar for private insurance, you might think about self pay or at least talk to them at the seminar about it and what the payments would be. Are they making you turn all the forms in before you go to the seminar?

You might talk to your HR lady but more than likely they will tell you they can't do anything. Most who I have heard that fight the insurance companies do that by hiring a lawyer or getting their physicians to send letters stressing how it is medically necessary for them to have the surgery. But those cases are usually people who's insurance pay but may reject a person for some reason. If your insurance doesn't cover bariatrics at all,,I don't think there is much you can do about that.

If your parent would do that for you, that would be awesome. I think you can stay on a parent insurance till age 26 but I don't know the stipulations.

Try to get to a seminar somehow and talk to someone in person. Don't give up till you've weighed every option.

Good luck! I'll pray for you!

[allygator 1]

If you are under 25 you can get back on your parent's policy with the new health care laws that were passed. I would look into it if that is the case.

[MikeSchor 0]

is it even worth talking to my HR dept about it? im curious about getting an individual insurance plan that isnt through my workplace. but i remember a year ago it was a fortune due to my weight, but it's sounding worth it to me. im also a part-time college student so im wondering if i could get re-added to a parents plan and try for that. im so beyond frustrated.

My answer at the beginning was "no" also. However, when I talked to HR I found that the more expensive plan that was offered did cover 90% if medically necessary. I switched to the plan, which can only be done at one particular time of the year, so I could get the surgery partially covered. I'll switch back to the less expensive plan in June when I will be allowed to change back. It won't matter much (except to save me money) because the pricey ins. doesn't cover fills/unfills anyway.

Hope this helps.

Michael

[justplaintired 0]

Okay, what I understand is this...if your medical policy has an EXCLUSION for bariatric surgery, you will not be able to appeal. I was told that you can appeal to the HR dept of your company to see if they will make an exception for you but they don't normally do so. The reason being, if they made an exclusion for one person, they would have to make an exception for others. At that point, why have the exclusion in the first place? I found out that it isn't uncommon for an employer to purchase an insurance policy that has bariatric (or fertility) exclusions. UGH!

I know about this because the policy we had last year had an exclusion. So, during open enrollment I checked on all the other options and only ONE policy did not have that exclusion. It is the most expensive but it is worth it being that I could not afford to self pay.

So, my advice would be to see if your parents' policy has the exclusion and if not, try to switch to theirs. You have to specifically call the insurance company and ask if they cover medically necessary bariatric surgery.

I wish you good luck. I know how disappointing it is to find out about an exclusion...it feels like the door is slammed in your face. However, if you investigate your other options, maybe you will find what you are looking for.

so i have all of this paperwork to fill out before the seminar on Jan 22nd. ive got the base of it finished, the last two pages are 30 questions for my insurance company representative.

the first question is do i have benefits for weight loss surgery for morbid obesity if medically necessary? then, i choose yes or no. if yes, i am suppose to complete all 30 questions...if no, i need to ask the rep to read the exclusion to me, then it says if i have an exclusion in my policy, would i self pay for surgery, and i cant. and if i say no, i dont even go to the seminar, it just ends there.

ive emailed a rep and all it said, point blank, is your plan does not cover obesity related surgeries. so is that it? its just over? I dont understand. i thought going to the seminar would help me through all of this. and i thought if it isnt included in my plan i can "challenge" it? am i wrong?

[pinklove11987 0]

so i have all of this paperwork to fill out before the seminar on Jan 22nd. ive got the base of it finished, the last two pages are 30 questions for my insurance company representative.

the first question is do i have benefits for weight loss surgery for morbid obesity if medically necessary? then, i choose yes or no. if yes, i am suppose to complete all 30 questions...if no, i need to ask the rep to read the exclusion to me, then it says if i have an exclusion in my policy, would i self pay for surgery, and i cant. and if i say no, i dont even go to the seminar, it just ends there.

ive emailed a rep and all it said, point blank, is your plan does not cover obesity related surgeries. so is that it? its just over? I dont understand. i thought going to the seminar would help me through all of this. and i thought if it isnt included in my plan i can "challenge" it? am i wrong?

Legally if you have any mobliities your insurance SHOULD cover it.

i know that Lap Band could fight for it. you have to just push them ans keep on calling them. DON'T GIVE UP! it took me 7 months to get my insurance approval and hopefully i'll have my surgery this month but as i said you have to push them and keep on asking questions. it's a difficult process but i'm sure it's worth it.

[BlairE 1]

I had read a previous post about a week ago from a young lady who had done exactly what you are thinking about.... she went back on to her parents policy b/c of the new laws. When you have them check there coverage make sure you ask whats covered as of Jan. 1. At first she was told her parents policy didn't cover it but her mom then went to her HR dept. and found that as of Jan. 1 it was a covered benefit. The ins. company then realized they made a mistake and gave her wrong info. She is now approved. As far as your seminar goes, until you get your ins. issue settled go in under the pretense of self pay so you can get in the door and see what they have to say. I think they just want to see how serious you are about following through the whole process. If you have no insurance options they have many programs available for people to use for self pay. They don't expect you to pay the whole amnt. up front if thats what you're afraid of...Good Luck!

[morgandonor 0]

update: so my mom isnt ALL THAT supportive of lapband. dont get me wrong, she thinks its a good idea, but she feels like i should "try everything else before it" but ive done it all. every diet, had trainers, etc. and she is saying its "too late" for her to add me to her insurance. shes going to double check, but she works in insurance, so i fear she knows. she also feels i wont be able to get my own plan because my bmi is 52, so no one will willingly insure me. she thinks my only option is self pay which she does not support since im deep in student debt and other stuff, i feel so confused.

what are payments like for self pay?

so upset.

[Metime 2]

When you add a person to your insurance you have to do that during Open Enrollment. Likely what your mom is telling you is that Open Enrollment is closed, it is typicaly a very short window for this type of thing. YOu can make life change additions, like when you have a baby, get married. I don't think that you being added would fall under that rule. You should ask your mother when their Open Enrollment period is then us the time between now and then to show her that this is a good option for you. At a BMI of 52, what exactly does "try everything else..." entail is a question you should ask your mother. Good luck.