Another Conversation with BCBS

crosswind · March 15, 2011

I just talked to my insurance rep about approval on a policy after the fact of VSG. She told me that, first of all, if my BMI was over 40 that I was uninsurable. I am *right* at the line, just under 40, so the underwriters told her that I might not be approved anyway because I may be considered too close to the line.

FACT 1:

IF YOUR BMI IS OVER 40, YOU ARE POTENTIALLY UNINSURABLE BY MAINSTREAM CARRIERS

She also told me that if I had already had VSG and I was applying for a policy and did not disclose it at time of application, on discovery the policy would be rescinded.

FACT 2:

IF YOU LIE TO PROSPECTIVE HEALTH INSURANCE CARRIERS, IF THEY FIND OUT THEY'LL CANCEL YOUR POLICY IMMEDIATELY.

She also said that if I was 'contemplating bariatric surgery" at the time and I did not disclose that, my policy would be rescinded upon discovery. However she also said that if t I was contemplating the surgery beforehand and I did disclose it, and they wrote the policy for coverage, later discovery would *not* mean it was rescinded.

FACT 3:

IF YOU ARE CONTEMPLATING SURGERY AT THE TIME YOU APPLY FOR REGULAR HEALTH INSURANCE AND YOU TELL THEM THIS, LATER DISCOVERY OF YOUR SURGERY WILL NOT RESULT IN POLICY CANCELLATION.

Blue Cross Blue Shield, according to her, will not insure people who have had any bariatric procedure within the past two years.

And finally: she quizzed me very carefully once I had asked her about this and she talked to the underwriters about whether or not my weight was accurate. Because I had asked about this, the underwriters were dubious that I was telling the truth about my BMI, because as far as they knew bariatric surgery is never performed on anyone who has a BMI under 40. They thought that because I was trying to get a clear answer about this I might actually be over 40 and lied on my application for general health insurance. I told her yes, it was accurate, and that in insurance scenarios you can't often get approved under 40 but as a self-pay patient being over 40 is not a hard and fast rule.

The underwriters apparently did not know this and so she asked me several times if I was perhaps fabricating my weight for insurance purposes.

Anyway, interesting conversation. Take what you need.

Hawaii50 · March 17, 2011

Hi there!

It sounds like we are in the same boat. I don't have insurance and just today found out I was declined by Kaiser due to my BMI (40.2) and that I disclosed my surgery date for VSG. (3.28) I looked into my state's insurance from another post you made and found that it is over $300/month and still won't cover any issues that come from a pre-existing condition within 6 months of my coverage date.

I also had a similar conversation with BCBS earlier this week. I am considering going back to my self-pay surgeon in MX for the 3-month follow up since I can't get a PCP easily. What are you considering-do you have a surgery date? My husband has Kaiser through his employer and we've never added me onto it due to cost. I wonder if I try to get on his next Jan, if I will be declined- I have read that you need to be 2 years/5 years post op without complications to re-apply to Kaiser and BCBS.

~Heidi

crosswind · March 17, 2011

Hi there!

It sounds like we are in the same boat. I don't have insurance and just today found out I was declined by Kaiser due to my BMI (40.2) and that I disclosed my surgery date for VSG. (3.28) I looked into my state's insurance from another post you made and found that it is over $300/month and still won't cover any issues that come from a pre-existing condition within 6 months of my coverage date.

I also had a similar conversation with BCBS earlier this week. I am considering going back to my self-pay surgeon in MX for the 3-month follow up since I can't get a PCP easily. What are you considering-do you have a surgery date? My husband has Kaiser through his employer and we've never added me onto it due to cost. I wonder if I try to get on his next Jan, if I will be declined- I have read that you need to be 2 years/5 years post op without complications to re-apply to Kaiser and BCBS.

~Heidi

Hi Heidi:

Blue Cross told me five years, United Healthcare told me two. I realized I had a COBRA policy I can opt into but the price is unbelievable: they quoted me 1,322.00 a month to stay insured, and it's Anthem so I'm not sure if they would cover anything that happened anyway. What I'm thinking is I'll just cross my fingers and pay COBRA for a couple months, and then go out looking for cheaper insurance. I remember Aetna told me that you had to wait six weeks before applying after a major surgery or pre-existing diagnosis and they would look at applications on a case-by-case basis.

I don't qualify for HIPAA or CHIP because I have COBRA; if I have a valid offer I don't qualify until it's exhausted.

But basically I think what's going to happen is as soon as I'm sure I'm not going to have complications, I'll drop insurance and go bare. I am *quite confident* that barring any complications I am going to be a lot healthier after this surgery. Most routine stuff -- cold, bladder infection, etc, is cheaper out of pocket anyway. Most health conditions in middle age are related to diet: diabetes, heart problems, cancer -- all of it is either entire or somewhat related to that so the likelihood of my having a heart attack or something *after* this surgery is kind of small.

This is clearly the biggest risk self-pay patients face but later on I wonder who else will be stuck between a rock and a hard place, unisurable because of their sugery they got while on another carrier.

I spent some time following links from an initial link that promised to have "gastric bypass insurance." All I got back was a quote screen where I could leave a name and number for agents, to call: most of them were BCBS, Aetna, etc. Not sure what they're up to there. If you're not insurable over 40 and you're not insurable after bypass, it seems what insurance companies want us to do is diet and exercise so we never bother them with any kind of bill at all.

Hawaii50 · March 17, 2011

"If you're not insurable over 40 and you're not insurable after bypass, it seems what insurance companies want us to do is diet and exercise so we never bother them with any kind of bill at all."

So true it seems.

It is reassuring that Aetna may be an option for 6 weeks post-op...I'll check into that. Seeing as I haven't had insurance for over 5 years, and am healthy except my weight, I am ok paying out of pocket for my preventitive health care, which has been very minimal. I am most concerned with the immediate post op aftercare from 1 day-3 months coverage.

Keep me posted if you find anything else worth checking into and I'll do the same.