Please Help Tough Question

[bbrecruiter2000 1]

Hi,

I thought of posting this under insurance but this is a long term problem for ALL long term bandsters and I am encountering this now.

I have had a lapband for 3 1/2 years. It was paid for by Motorola and the network was CCN and now Humana. My husband got laid off in late July and our insurance expires November 30th. We have the COBRA option, but decided it was cheaper to look into an individual plan for our children through Unicare here in TX. My husband and I decided to research options separate from our children due to the fact that I have a lapband and didnt want to be turned down without talking to some folks first.

I called a few insurance companies to discover that I am high risk and uninsurable because of my lapband. We are talking about individual plans (not to be confused with group plans through employers) No one will insure me it seems regardless of the fact that I am healthier, have no health issues and I am no longer morbidly obese. It seems my only option is to pay 400.00 plus for Cobra until my husband finds a job with group insurance. Does anyone know of any insurance company with an individual plan that will insure me that is cheaper than COBRA? IT is possible that my husband may opt to work for a really small consulting firm that may have insurance, but as a very small group, they will also have underwriting requirements and I will likely be turned down anyway since I dont know what constitutes a group and the company will not be self insured. Besides the COBRA will run out in 18 months and at that point, I would have to get insurance and with a lapband, I would only qualify for the TX high risk pool which probably would cost more than the COBRA. I cant believe this. Surely there must be insurance available to me? I would even consider an exclusion for any band related maintenance or problems since I dont have any and dont expect to in the near future. If it became a problem, I would just go to Mexico and have it removed.

Any ideas??? Please??

Babs in TX

334/190 ish

[Busy 0]

Babs,

First, I do not have an answer to your question, wish I did. But are you saying that you cannot find an insurance company that will insure you since you got your band or they classify you as high risk? Currently I do not have a band but am trying to get one. The insurance thing does concern me.

PJ

[bbrecruiter2000 1]

Hi,

Busywoman: I have always had group insurance (through a company) where there are no underwriting guidelines. If you were to lose your job and could not find another before your group insurance expires (which is my case) then in order to have health insurance you would have to buy an individual plan since you were no longer part of a group and no longer had an employer. I am self employed and my husband has always worked for large companies IBM and Motorola. Both companies are self insured and pay the bills but use a network like Humana or CCN PPO to administer the plan and provide the network.

My present situation is that my husband is no longer employed, our insurance is running out and I need insurance. COBRA is an option, but the premium is at 102% of the normal premium that the employer formerly paid for my group plan. It means I have to pay it myself. For my family of 4, the monthly premium is $1,400 dollars. The only folks that would want COBRA are people who cant get insurance because they are considered high risk. Having any kind of bariatric surgery within 10 years excludes me from most plans. That is why I am asking for help. Someone here who is self employed or pays for their own insurance may have the answer I am looking for....

Babs in TX

[Nathalie 4]

The only folks that would want COBRA are people who cant get insurance because they are considered high risk. Having any kind of bariatric surgery within 10 years excludes me from most plans.

Hi Babs -

I wanted to address the point above. COBRA is not just for people who can't get insurance. It is for continuation of insurance. If you are insured and then have a break in your insurance, companies will look for any reason not to offer you insurance as soon as you are eligible for group coverage. Many states have waiting periods for up to a year or longer depending on the length of your break in insurance. With COBRA, you will have no break, and therefore the new company must continue the insurance coverage. You will not be a "high risk" or be excluded from plans.

If you do not opt for COBRA and lapse your insurance coverage, then you will have what the new insurance company will consider a "pre-existing condition," which is why they may try to deny coverage, or have exclusions for you based on the band.

In my opinion, the best option is to go with COBRA if your husband will have new insurance soon. I know it is expensive, but it is worth it. Through COBRA you are covered under the same insurance plan you have now. When your new insurance is offered, you have a certificate of coverage to provide the new insurance company, and therefore your band is not considered "pre-existing condition." you will be eligible for coverage immediately.

When I got laid off I elected COBRA coverage at $760/month. However, I had a new job in 3 months, and submitted my Certificate of Coverage to BCBS. We were covered from day 1, no questions or denials of service. Had I not elected COBRA I would have had a 12 month waiting period for coverage of any pre-existing conditions. Additionally, I would have been eligible for insurance after 3 months with the company, because you have to wait the same amount of time that you were without insurance before the new company will cover you in the state of MI.

Do your research. I believe you have 90 days from the time your coverage lapses (it may be 60 days) to elect COBRA, so you don't have to do it immediately. However long you wait, when you sign up for it, you will have to pay the entire premium for the back-coverage.

I hope I didn't give you too much unnecessary (or unrequested) information. Regardless, good luck with your decision.

Nathalie

[Busy 0]

Babs

Thanks for the response. I will be watching the responses you get just for future information. I also have group insurance, (state employee) but was unaware that I would be considered high risk for 10 years if something happened to my job and I was no longer covered under the group insurance. I consider that valuable information. Good luck with your search and thanks for the info.

PJ

[Alexandra 55]

Babs, insurance laws vary considerably from state to state. You really have to be investigating only what's available in YOUR state. Not every state allows individual insurers to underwrite, so in some situations people with bands are not considered higher risk than anyone else. Care of their bands might be excluded as a pre-existing condition, but in states with guaranteed-issue individual policies (like New Jersey) they can't be excluded completely.

That said, I agree that keeping your current coverage through COBRA is your best bet. You might try taking your children off your contract if there are other options for them, but if not it's going to be worth the cost to keep your coverage in force. When I'm advising people in this situation in New Jersey, even with the guaranteed-issue individual policies available it's ALWAYS better to continue the group coverage. You will always get much more coverage for the premium paid; individual coverage is pretty much only good as an utter last resort.

Good luck, and I hope one of you gets access to a group policy soon!

[babsintx3 0]

Hi,

Thanks for your responses. I am going to keep the Cobra for the moment for myself. My husband is another matter since he does not have any major health issues and should be insurable. I am going to look into some additional options for him. My kids are covered now for the moment and that was my biggest concern. THanks for all the info.

Babs in TX