Old Vs. New Insurance

[MK1986 78]

I have BCBS of Louisiana which doesn't cover the sleeve and in six months our company is switching to BCBS of WNY which covers the sleeve!!! My question is..Should I wait til the six months are up to see the nutritionist and psych or do it now under the old insurance. Did you have a deductible to meet before getting your surgery?

[MK1986 78]

Also did you have a copay for the surgeon's office?

[IsB 209]

It all depends on your plan. For mine I have copays at the surgeon's office and have to meet my deductible. Between all the blood work, cardio tests, upper GI, endoscopy, by the time I get to the surgery I will long since have met that deductible. I also have 20% co-insurance which means they only cover 80% of the hospital procedures and surgical fees. I'm responsible for the remaining 20% up to $16,500 for everything

You really need to look at your plan carefully because all those things going towards the deductible will not transfer over to the new plan so it's going to cost more that way.

[chitowngirl 885]

Hmmm.... First I would make sure that the new insurance doesn't have a pre-existing clause. As long as it doesn't and the deductable and out of pocket expenses are not a issue, I would go for it.

[MK1986 78]

OK cause I know the new ins. Requires a 6 month diet. I plan to see my PCP under the old insurance. Also the new insurance says that it just requires pre authorization

[MK1986 78]

I just hope that I have a big deductible

[TinkerToyz 45]

I don't think insurance can deny coverage for a pre-existing condition as long as you have been continually covered by medical insurance prior to the new policy.

[chitowngirl 885]

I work in healthcare and deal all day with insurance. Pre-existing clause does not consider if you have had prior coverage. I would start the 6 month pcp diet, just because your new insurance eis saying that you only need prior authorization, does not mean that you dont need the diet. When they do authorizations they follow a list of recommended guidelines for the certain procedure, most insurances request weight and diet history. I would do it just to be on the safe side. If I had to guess I'd say about 80% of insurances will not approve bariatric surgery with out supervised diet history.

[MK1986 78]

I work in healthcare and deal all day with insurance. Pre-existing clause does not consider if you have had prior coverage. I would start the 6 month pcp diet' date=' just because your new insurance eis saying that you only need prior authorization, does not mean that you dont need the diet. When they do authorizations they follow a list of recommended guidelines for the certain procedure, most insurances request weight and diet history. I would do it just to be on the safe side. If I had to guess I'd say about 80% of insurances will not approve bariatric surgery with out supervised diet history.[/quote']

OK great! Thanks for the info!