INSURANCE REQUIREMENT... 3 Years

[MizzouFan1 88]

So, my hubby just got a new job and I was all excited about the possibilty of them covering lap-band which they do but one of the stipulations is that you have to be with the company 3 years before they will approve. I am so totally bummed and just defeated. Has anyone heard of this or had luck with talking to HR about changing the time restraints. My husband works for the a large state university. Any help at all would be greatly appreciated. Thanks!

[Jess55 97]

That's strange. When I had my surgery, my company had switched insurances 3 months prior and that worried me if they would cover it. I have Oxford freedom (now my company is switching back to empire bcbs) but they covered it right away after I did all the tests and 6 month diet thing.

[emjay 8]

So, my hubby just got a new job and I was all excited about the possibilty of them covering lap-band which they do but one of the stipulations is that you have to be with the company 3 years before they will approve. I am so totally bummed and just defeated. Has anyone heard of this or had luck with talking to HR about changing the time restraints. My husband works for the a large state university. Any help at all would be greatly appreciated. Thanks!

If they are self-insured the company can basically put in any time constraint they want to since it is not considered an essential health benefit. Many self-insured plans, mine included at the moment, do not cover WLS at all. That stipulation is probably put in there so they don't end up paying for a surgery and then the employee leaving shortly after. Do I agree - No. Just telling you like it is. Since it isn't a coverage that is mandated (and if it is a self-insured plan, it's an ERISA plan which means it's under Federal and not State Law) then the fact that it's covered at all is a bonus, but not the time frame that is required in order to consider the surgery.