Does anyone know...

Laura W · March 5, 2004

A question was asked on another board about the lapband and insurance. If you have the lapband and end up changing jobs or insurance, will you be insurable? Some say that insurance companies won't cover you if you've had the band. Anyone know?

Alexandra · March 5, 2004

Hi Laura,

Insurance is regulated by the states so the rules will vary depending on where you live. AS A RULE, though, group insurance provided by an employer cannot discriminate according to the employees' state of health. If you get a job you will be eligible for the employer's policy according to the terms of that policy.

With individual insurance, though, all bets are off. The state of New Jersey has guaranteed-issue individual coverage, but not all states do. If your state underwrites individual plans according to health factors (like height and weight, prior conditions, etc.) you may not be eligible. THAT SAID: I firmly believe the existence of a Lap-Band should be considered like any other implant--it is not a medical condition and if you've lost weight, you may not any longer be morbidly obese (a category which may render one uninsurable, indeed).

If anyone is denied insurance SOLELY for the reason of having a lap-band, I'd strongly suggest consulting a lawyer. There is no reason at all to think that the presence of a band will result in further health problems down the line, which would, theoretically, be the reason for denial.

shellyj · March 5, 2004

UNFORTUNATLY i know all about this.

i had ins that covered the lapband last year this year my ins changed to bcbs blue cross of bull shit

they do not cover any wls procedure because they have a specific exclusion for wls. any wls related dr visit is not covered at all. i have contacted attorneys, the state of tn, bcbs and i am NOT COVERED at all when it comes to my band.

if you are switching policies make sure you FIND OUT dont just take one persons word either because they usually dont know. i actually spoke to a manager at bcbs to make 100% sure. i can appeal anything they dont pay but since there is a specific exclusion the chances are slim to none that they would cover it.

michelle

Alexandra · March 5, 2004

Shelly, is your plan a large-group plan? I mean, does your employer have a say in what is an isn't covered? Or is the exclusion part of Blue Cross's standard plan in your state?

shellyj · March 5, 2004

no there are only 6 employees where i work so it is a VERY small plan

the policy has the exclusion. the state of tn doesnt have any laws that would force them to cover a pre-existing condition since the condition is specifically excluded.

the sucky part is that my employer is probably only saving a few hundred dollars for the YEAR and it potentially could cost me alot.

since i am also having problems getting restriction (at 4.1) i cant even get it fixed till i get new insurance and then i'll have to wait 1 year to because the pre existing condition hasnt been covered in the last 12 months.

GeezerSue · March 5, 2004

Originally posted by Laura W
A question was asked on another board about the lapband and insurance. If you have the lapband and end up changing jobs or insurance, will you be insurable? Some say that insurance companies won't cover you if you've had the band. Anyone know?

Two different issues are getting confused here. I have no background or training in this area, save many years of dealing with insurance companies. But here goes:

1(a)--Will you be insurable on you new company's group insurance or when your company changes carriers. Yes. That's what group insurance is all about.

1(--Will you be insurable on your own? Depends on the policy and they'll probably exclude any treatment involving the band, routine or emergency, as well as treatment for morbid obesity.

2(a)--Will your new insurance cover adjustments to an existing band? Who knows? But I wouldn't count on it. (If the new insurance policy covers the band surgery, then it should cover adjustments for the "already-banded" who end up being covered on that policy.)

2(--Will your new insurance cover other health issues, including emergencies, involving the band? If it wasn't already "excluded," [see 1( above] I'd fight for coverage if/when the need arose, based on the "like any other implant" position mentioned above.

Sue