Obesity as a Pre Existing Condition? WLS for Dummies

sherilynn · November 14, 2006

Hey all...

I just got my Weight Loss for Surgery book (enjoying it so far). But they brought up a point that my insurance company may consider obesity a Pre Existing condition, when I get my new insurance (open enrollment now) in January. Has anyone had waiting periods, etc. due to obesity being a pre existing condition? I'm concerned.

antivicky · November 14, 2006

I am in my open enrollment period also. I had BCBS with my DH and it did not cover surgery... I was self pay and had the surgery in May. I am considering signing up with my Company (Definity Health) because I have heard they cover most things with the band... but is that after the fact also???? If I have a complication will they consider it pre-existing and not cover???

Alexandra · November 14, 2006

Regulations about pre-existing condition exclusions may vary from state to state, but generally speaking the following applies: If you are enrolling in a health plan on an approriate eligibility date (such as open enrollment, taking a new job, becoming newly eligible due to marriage, etc.) pre-existing condition exclusions do not apply.

Antivicky, you've asked a different question. If you are self-paying because your insurer excludes banding or other WLS, treatment for complications might be excluded based on the fact that your surgery wasn't covered. However, emergency treatment can't be excluded for any reason, so if you're getting treated for some emergency related to your band that should be covered.

As always, check with your insurer for specific contract terms, and it's also a VERY good idea to find out what your rights are with regard to health coverage in your state. Check your state's website for information on HMOs, health insurance, and related regulations.

antivicky · November 14, 2006

Thank you for your reply. I am may not have been clear... BCBS would not cover and that is why I was self pay... Definity Health is the plan that I can go for during open enrollment and they do cover the procedure (little late for me now)... I was just wondering as an example if I had to have a port replaced (not an emergency) do you think they would cover that? I hate to pick up Definity if they would not cover any of the procedures... because I would still have BCBS with my Husband. It would be an additional $80 a month but it would be worth it if they would pay in the vent I had a problem. Thanks again for your reply! Any info would be appreciated.