Does individual insurance work?

[jules99 0]

I called my insurance provider today BC/BS of Oregan and they said WLS is an exclusion to the plan. Of course! However, my question is this...

Many people that work from home or have small business often purchase their own insurance plans. Has anyone researched this method? Even with the hefty premiums, it's not as bad as a $20k surgury!

Thanks

[Alexandra 55]

It all depends on the laws in your state, Jules. In NJ, if you're eligible for a group plan you're not even permitted to buy individual insurance. But on the flip-side, self-employed people with only one other employee or partner can qualify as a small group and buy a group plan for themselves.

The laws vary considerably from state to state, so you should call a broker in Oregon and find out what the situation is where you are. It may very well turn out to be more cost-effective. I know of several people here in NJ who have done just that and it's worked out great--especially because as a small employer you have your pick of carriers and can find a band-friendly one.

Good luck!!

[Penni60 45]

My sweetie and I have purchased small business insurance and I can tell you it does work. Although they did not cover the initial surgery they did cover all but $900 of the removal. I have PacifiCare PPO. Of course now I have heard that United Healthcare is taking over the PacifiCare people. So who knows what my plan will be then. But for now it is working for me.

[jules99 0]

Well, my employer's headquarters are in OR, however, I live in NY. So what you're saying is that my husband and I could apply for small business insurance and pay the premiums and be covered for this type of surgury?

Thanks for all your help:)

[Alexandra 55]

Jules, if you're in NY you may have more options. Is your husband employed in NY? Self-employed? I may be able to help you with small-group coverage in NY, but we should talk off the board. Check your PM box.

[bluenightmare 0]

I am from NY as well with BC insurance. They have denied me for the lab band. I too am looking into paying for my own insurance that does cover it. If you learned anything that you can share??

[Alexandra 55]

Bluenightmare, what was the reason for the denial? I know BC in New York covers banding, so what was their specific reason? Are you on a group policy that has an exclusion or something?

[Dianechef 3]

I live in AZ so I have no clue if this applies to you at all, but thought I'd throw it out there.

When we applied for Individual Health Insurance, not only would they not cover me for any WLS, but they wouldn't even cover me for Health Insurance AT ALL!! NONE!! ZERO!! They claimed I exceeded the weight limit & I was turned down. (Hello!?!?!? That's why I am WANTING Health Insurance!!!) I had BCBS & it sucks!!

I was told that BCBS for people with Individual Health Insurance NEVER covers WLS at all. At least that's what it is here in AZ. Yours could be totally better.

[Alexandra 55]

Diane, it SUCKS to live in Arizona and need health insurance. I hope and pray that someday soon it will be illegal to deny anyone health insurance. The new Massachusetts law should set the stage for other states to follow suit, if it works. But for now, the states make their own insurance laws and some are just way worse than others. AZ is particularly backward in this regard. Thankfully, that sort of exclusionary underwriting for health insurance is not the norm in most states.In NY and NJ, for example, individual health insurance can't be denied to someone for health reasons.

[bluenightmare 0]

Sorry No that was a typo I have Blue Shield. They don't cover the band they said it was under investigation. They cover bypass with out hesitation.

[bluenightmare 0]

I have kept on my searching for independent insurance. I have yet to find anything that I can a) know that covers it and :confused: how to go about getting a different insurance then what my job offers. Any help would be much appreciated. I live in NY if that helps.

[TheWomanWithin 0]

Diane, we are in the same boat as you. And I was turned down for individual ins once - that was at 40 lbs overweight through Humana one - so we went with BCBS a small business plan - it pays some things but not others and excluded WLS at all in FL as of 12/31/05.

I finally found this company (United American Insurance) that if you are over a certain weight will cover you they just up your premium some. For us it was $26 extra a month - STILL alot better than paying $689 per month.

Im waiting on them to fax or email the specific papers to say yes to WLS. Then they said it's a 6 month wait to be covered for surgery.

Anyone ever heard of them or used them?

[FunnyDuddies 6]

I am very curious to find out what you hear from them, because I am in clearwater and would be glad to have insurance cover WLS rather than out of my own pocket. There are many good things we want to put that money towards. :confused: Like new boobs. HAHAHA

I know that with most individual and small business insurance co's the turn down rate is staggering. And the approval process is much more difficult.

[Alexandra 55]

I have kept on my searching for independent insurance. I have yet to find anything that I can a) know that covers it and :confused: how to go about getting a different insurance then what my job offers. Any help would be much appreciated. I live in NY if that helps.

Bluenightmare, if you are in New York I know for a fact that the "investigational" denial has been overturned time and time again by the third-party review process in that state. Go ahead and start the process with your doctor, get all your testing and pre-op care done as though you were going for bypass. Then when your surgeon puts in his request for precertification of the band, it may or may not be denied. (Carriers change their tune all the time, and what you're being told on the phone just may not be true anymore by the time your request is submitted.)

If it is denied based solely on the grounds that the band is "investigational" you have excellent grounds for appeal. I am confident that you will easily get that overturned with enough patience and persistence. You can't get individual insurance if you have group, so if you're on your employer's plan that's your only option for coverage (unless they offer difference policies).

Are you qualified medically for bariatric surgery? Then go for it!!

[Tricia K. 0]

I'm sorry you're having difficulty obtaining health insurance that will cover WLS. My insurance company didn't cover it so I was a self-pay patient. It's tough, but I wasn't about to let the insurance company dictate my life. I took it in my own hands. Good luck to you.

When we applied for Individual Health Insurance, not only would they not cover me for any WLS, but they wouldn't even cover me for Health Insurance AT ALL!! NONE!! ZERO!! They claimed I exceeded the weight limit & I was turned down. (Hello!?!?!? That's why I am WANTING Health Insurance!!!) I had BCBS & it sucks!!

I feel your pain. In early 2004, I applied for individual coverage with Ocshner (now Humana) and was denied due to not fitting within their height/weight charts. I currently have COBRA coverage through BCBS of Louisiana but was recently denied individual coverage through them BECAUSE I had weight loss surgery. I was also denied for the same reason by Humana One and Coventry. BCBS of Louisiana did state the reason was "because you had weight loss surgery within the last one (1) year" and that I could apply again after my 1 year anniversary but they wouldn't guarantee coverage. I've been with them this long under a group plan, they know my medical history as well as my history of doctor visits/prescriptions/etc., yet they won't give me individual coverage right now. I even asked that they write in an exclusion for anything related to my surgery, but they wouldn't even do that.

Ugh..I can't win for "losing." :faint: