What Insurance Can I Take Out To Cover Sleeve?

[Candace Dillard Stewart 1]

hey everyone! It took me a while to find my denial letter from BCBS but I reapplie with United Healthcare and was denied yesterday so I mailed of my forms today so hopefully in a few weeks I will be covered and be able to start this process!! Thanks for the help!!

[kczar 166]

hey everyone! It took me a while to find my denial letter from BCBS but I reapplie with United Healthcare and was denied yesterday so I mailed of my forms today so hopefully in a few weeks I will be covered and be able to start this process!! Thanks for the help!!

That's great, Candice! Since you'll be getting the paperwork to them after the 15th, your coverage will probably start May 1st. They'll send you a letter that you can use as proof of insurance because it sometimes takes a while to actually get your ID card. They also offer a "health partner" feature where a nurse contacts you on a regular basis to help you set goals to improve your health. Pretty much everyone I have spoken to there has been very helpful.

When I was looking for a WLS, their website only showed someone in Louisiana (I'm in Texas). But I called them and they were able to give the name of several surgeons that were in the network.

Good luck!

[Candace Dillard Stewart 1]

Yes that's where the surgeon I found was, New Orleans actually. And my mom had the sleeve almost a year ago next month, and her doctor is in Slidell and I would really like to use him, so hopefully maybe I can do that same thing and call in and find one a little closer. I am only an hour from New Orleans but I really don't want to make that drive.

[stephanieloribeth 0]

Question for you ladies.... I' in the process of trying to figure out how to be able to afford to get the sleeve done.

And I know no insurance company will cover me without having to pay out the butt. I've started an application for a few

different insurance companies, but they want me to pay before I find out if I'm accepted or not, and that just isn't okay with me.

I was wondering if yall has any suggestions? I did my application online, so I'm wondering if it would be different on the phone.

Any advice would be appreciated.

[kczar 166]

Question for you ladies.... I' in the process of trying to figure out how to be able to afford to get the sleeve done.

And I know no insurance company will cover me without having to pay out the butt. I've started an application for a few

different insurance companies, but they want me to pay before I find out if I'm accepted or not, and that just isn't okay with me.

I was wondering if yall has any suggestions? I did my application online, so I'm wondering if it would be different on the phone.

Any advice would be appreciated.

I tried applying for two different individual insurance policies and was turned down by both because of my weight. (They asked for a check and/or credit card but they didn't process them since I was declined.) I then applied for PCIP, which is a government funded insurance program. It's specifically for people who have pre-existing health conditions and who have not had insurance for at least six months. It's not available in all states but it's a really good program.

I pay $306 a month (it's based on age groups) and it has a $2,000 deductible and $4,000 out of pocket maximum. So after my gallbladder surgery and endoscopy, everything was covered. I had my deviated septum repaired at no additional cost and will be sleeved in August.

So I'm paying about 7 grand this year but I've gotten a lot of health issues taken care of. If you're interested, go to the pcipplan.com website and see if your state is included. (And if you've been turned down by another insurance company, that counts as a pre-existing condition.)

Good luck!

[stephanieloribeth 0]

kczar... I was wondering if I could ask your weight and height.

I don't know if that's too personal or not.

[stephanieloribeth 0]

And I have another question for people with PCIP...

I know you have to have a six month diet for them to cover any bariatric surgery.

But does that have to be six months after your coverage started?

Or does previous dieting recorded by your doctor count for that?

Just wondering.

[kczar 166]

No problem. When I initially applied for individual insurance, I was 5'8" and weighed 294. After I was denied by one company, I fudged and said I was 250; still got turned down. PCIP doesn't care about that. They also offer a service where a nurse will call you on a monthly basis to check on your health goals and give general support and advice.

Keep in mind that if the insurance is available in your state, the only requirements you have to meet is to either have a pre-existing condition or have been denied health coverage and be without insurance for six months. You will not be turned down. If your paperwork is in by the 15th, coverage starts the first of the next month. The program is supposed to go away by 2014 but that should be plenty of time.

As far as WLS, they require a six month monitored diet program, a BMI of 35 or more with two co-morbidities or a BMI of 40 or more without.

ETA - I don't think the diet program has to be done while you're covered under the insurance but I'm not sure. They do require detailed information about your diet, exercise, etc. Your surgeon's insurance coordinator can check on this to be sure.

[stephanieloribeth 0]

So they only take into account the dieting AFTER you join PCIP?

Not if you've had it in your files for years?

[workingmotherofthree 24]

Love all of these insurance discussions

[workingmotherofthree 24]

Sorry, meant to add that I have learned a lot about coverage and the process as I am waiting for my insurance company to approve as I needed to request my husbands HR team to override the exclusion on the plan. I sent a very detailed letter of my history and complications after a ,ajor accident and then gaving three children via c-section and a fibroid tumor that needs to be removed because of its size. its been 3 weeks so I am calling again today as I self paid at the hospital in the fall of 2011 to go throygh the progam.....so, I have learned a lot via reading the posts, thanks