BCBS and Humana says band is auto decline

[skbishop78 0]

Hey, I work in an insurance agency. I do not sell health insurance, but the health agent in our office came and told me that BCBS and Humana both have said that lab-band and gastric bypass are both auto declines for people applying for personal insurance. What does that mean? Well it means if your not on a group plan, and you are self employed...you can not get either of those companies to write your policy. They said that it is an auto decline for atleast 10 years until further research can be done. She then went on to tell me that if I ever go off group my only option from bcbs and humana would be a guaranteed issue which would run me about $300-$400 a month just for mine! WOW....what is up with this? I am healthier now then I have ever been and the band can be removed...why an auto decline? Just wanted to let everyone know. I don't about the other companies, but these are the 2 major companies that we represent in our agency.

[*susan* 1,709]

You know, I just don't understand that either. I was self-pay because BC BS of Florida would not cover mine. It seems to me, it will cost them a lot more money in having to cover all the related illnesses/problems that obesity causes than to just cover the surgery itself so we will be healthier and not have all those associated problems. Am I missing something here?

[snowhard 0]

Hey, I work in an insurance agency. I do not sell health insurance, but the health agent in our office came and told me that BCBS and Humana both have said that lab-band and gastric bypass are both auto declines for people applying for personal insurance. What does that mean? Well it means if your not on a group plan, and you are self employed...you can not get either of those companies to write your policy. They said that it is an auto decline for atleast 10 years until further research can be done. She then went on to tell me that if I ever go off group my only option from bcbs and humana would be a guaranteed issue which would run me about $300-$400 a month just for mine! WOW....what is up with this? I am healthier now then I have ever been and the band can be removed...why an auto decline? Just wanted to let everyone know. I don't about the other companies, but these are the 2 major companies that we represent in our agency.

This is something I'm very worried about too. I think one of the moderators is in an insurance broker? Perhaps she can help us out?

I don't get what you're saying though?? What is a guanteed issue? Also, this may be a silly quesiton, but if I am employed they can't by autodecline me right?

[Alexandra 55]

I've never heard that specific phrase before, but "auto-decline" would seem to mean that in situations where medical underwriting is done, people who are less than 10 years out from bariatric surgery would be declined for health insurance coverage. SKbishop, what state are you in? The laws vary considerably from state to state, so what's true where you are may not be true elsewhere.

"Guaranteed issue" refers to situations where insurance policies MUST be issued, regardless of medical or other circumstances. Some states, like New Jersey, have laws that guarantee access to health insurance for all individuals regardless of health status. Yes, it's true that those policies aren't cheap--$300 or $400 for a single person is about right--but they are guaranteed to be AVAILABLE.

Generally, insurance companies will decline as many people as they possibly can given the laws of the state they're operating in. They will charge as much as they can for people who are higher risk or decline to write those policies entirely. The only protection we have as consumers of insurance is to know what the laws are in our states.

Snowhard, generally speaking if your employer provides your health insurance, it's a GROUP plan and as such your personal medical situation is probably not relevant. But again, the laws in your state may differ, so do check that out with a licensed broker or your state insurance department.

[Fauxnaif 1]

Not that I like to be dishonest...but...

If we had our surgery and all fills in Mexico, there is no record of our surgery, right?

[Alexandra 55]

Fauxnaif, that may be true but it's not something to bank on. If an insurer got wind of any dishonesty on the application they'd be able to prosecute for fraud. Not to mention rescinding any benefits that had ever been paid out under the plan.

I would NOT recommend that course of action. The better way to go is find out if there's a high-risk pool in your state that gives access to the people who would normally be considered uninsurable. There may be higher rates to pay, but going without health insurance is extremely risky unless you literally have nothing left to lose.