Has anyone gotten independent insurance post op?

[sweetcurves3 57]

Just wanted to know, I plan on making some job changes in about 2 months and will not have an option for insurance through a job. Does anyone have any recommendations?

[makemyownluck 785]

I'm gonna assume you're in the US...

Most Blue Cross plans will decline you for any WLS in the last 3 years. After that, they may cover you, but you'll have to pay more money.

Aetna will decline you for 5 years.

Cigna is the most lenient, but I think even they decline for surgery within 2 years.

I work for a third party vendor, as an underwriter, so I'm quite familiar with what they look for.

You have to be a certain number of years our from surgery (as stated above), have a physical with blood work within 6-12 months and they will want to see a recent CBC and b-12 level. You will also have to be stable at your weight for at least a year. And your current BMI can't be over 32 (sometimes less, varies by carrier). A lot of these plans will max rate you for this history, so if you have any other medical issues or medications that you use, that could put you over the edge to be a decline. For example, if your surgery was just outside the "decline" period and your current BMI would require a rating also, you'd be declined. If you're still treating co-morbid conditions, you would be declined...

Also, if you were ever a diabetic on insulin, they will never cover you. Even on oral meds, diabetics are rarely eligible for insurance coverage.

Sorry to be a Debbie Downer about it, but you asked! Truth of the matter is, insurance companies want to insure healthy people. Plain and simple, as an underwriter, my job is to reject high risk applicants, and WLS patients are considered high risk... especially since most WLS are either lap band (which require frequent visits for adjustments) or RNY (which those patients have Vitamin deficiencies and such years after surgery). They group all WLS together, so they really don't consider that sleeve patients don't have the same ongoing care issues that lap band patients and RNY patients do. It's not fair, by any means, I'm just telling you how the insurance companies see it.

However, starting in October, you can apply for the Obamacare plans, and they can't decline you. If I were you, I'd start with Cigna (if it's available in your state), I find they are the most lenient.

The best advice I can give is to elect the COBRA coverage. It's expensive, yes, but you won't have to worry about being covered. It's only 6 months until you can apply for the Obamacare plans, and they are guarantee issue policies.

Good luck to you!

[sweetcurves3 57]

Thank you sooo much for the response. That was very helpful

[melissa130 135]

Please do your own research when it comes to insurance coverage that you may need. I am not sure I would rely on any information posted on this site, posted by people you do not know. Good luck to you though- insurance world is crazy.

[sweetcurves3 57]

Please do your own research when it comes to insurance coverage that you may need. I am not sure I would rely on any information posted on this site' date=' posted by people you do not know. Good luck to you though- insurance world is crazy.[/quote']

Thank you I'm still doing my own research of course and checking around with different companies.

[makemyownluck 785]

Melissa, you think I went to the trouble of responding that in depth to give misinformation? Furthermore, you think she needs advice from a stranger to do her own research? Take your advice, but not that from someone who actually knows something about it, huh? Great advice. Sheesh.

With that attitude, why would you even join a community like this?

Sweetcurves, if you need any other info, feel free to inbox me.

[melissa130 135]

it is not an attitude- just a different point of view. Is your opinion the only one that matters? I don't think so.

[No game 14,437]

Makemyownluck,

I think it was very sweet of you to take time out of your evening to give such detail about this.

And am sure the op is grateful! Don't sweat the small insignificant stuff

[fyre_storm 1,412]

I'm gonna assume you're in the US...

Most Blue Cross plans will decline you for any WLS in the last 3 years. After that' date=' they may cover you, but you'll have to pay more money.

Aetna will decline you for 5 years.

Cigna is the most lenient, but I think even they decline for surgery within 2 years.

I work for a third party vendor, as an underwriter, so I'm quite familiar with what they look for.

You have to be a certain number of years our from surgery (as stated above), have a physical with blood work within 6-12 months and they will want to see a recent CBC and b-12 level. You will also have to be stable at your weight for at least a year. And your current BMI can't be over 32 (sometimes less, varies by carrier). A lot of these plans will max rate you for this history, so if you have any other medical issues or medications that you use, that could put you over the edge to be a decline. For example, if your surgery was just outside the "decline" period and your current BMI would require a rating also, you'd be declined. If you're still treating co-morbid conditions, you would be declined...

Also, if you were ever a diabetic on insulin, they will never cover you. Even on oral meds, diabetics are rarely eligible for insurance coverage.

Sorry to be a Debbie Downer about it, but you asked! Truth of the matter is, insurance companies want to insure healthy people. Plain and simple, as an underwriter, my job is to reject high risk applicants, and WLS patients are considered high risk... especially since most WLS are either lap band (which require frequent visits for adjustments) or RNY (which those patients have Vitamin deficiencies and such years after surgery). They group all WLS together, so they really don't consider that sleeve patients don't have the same ongoing care issues that lap band patients and RNY patients do. It's not fair, by any means, I'm just telling you how the insurance companies see it.

However, starting in October, you can apply for the Obamacare plans, and they can't decline you. If I were you, I'd start with Cigna (if it's available in your state), I find they are the most lenient.

The best advice I can give is to elect the COBRA coverage. It's expensive, yes, but you won't have to worry about being covered. It's only 6 months until you can apply for the Obamacare plans, and they are guarantee issue policies.

Good luck to you![/quote']

Thank god for Obama care. My group plan costs 60 bucks. The insurance I pay for my partner is 600 and it went up 100 over 2 months. I can not wait for him to leave hippa

[Sadtosaygoodbye 256]

Melissa, you think I went to the trouble of responding that in depth to give misinformation? Furthermore, you think she needs advice from a stranger to do her own research? Take your advice, but not that from someone who actually knows something about it, huh? Great advice. Sheesh.

With that attitude, why would you even join a community like this?

Sweetcurves, if you need any other info, feel free to inbox me.

I have a question when you refer to the Obamacare plans, what exactly are these? I understand the medicaid expasion and private insurers and the setting up of health care exchanges. The Obamacare plan is new terminology for to me.

[sweetcurves3 57]

Melissa' date=' you think I went to the trouble of responding that in depth to give misinformation? Furthermore, you think she needs advice from a stranger to do her own research? Take your advice, but not that from someone who actually knows something about it, huh? Great advice. Sheesh.

With that attitude, why would you even join a community like this?

Sweetcurves, if you need any other info, feel free to inbox me. [/quote']

Thank you. Definetly will if I come up with any other questions. And just for the record I have already talked with 2 insurance companies before coming on here asking any questions. So I appreciate you detailed response.

[makemyownluck 785]

I have a question when you refer to the Obamacare plans, what exactly are these? I understand the medicaid expasion and private insurers and the setting up of health care exchanges. The Obamacare plan is new terminology for to me.

I'm sorry I wasn't clear! Let me try to explain...

When I say Obamacare, what I mean really are the new insurance rules, not really a specific plan. Once the new rules go into effect, private insurers won't be allowed to decline anyone coverage. They won't be able to exclude coverage for ongoing medical conditions (meaning, you can't have a rider to your contract saying they won't pay for anything related to, say, a joint replacement you've had, for example) and they won't be allowed to set pre-existing condition limitations on the plans. Also, there will be minimum required coverage - for example, preventative care, check ups, mammograms, pap tests, etc.

So, what I mean is that RIGHT NOW - most people with recent WLS won't qualify for insurance with MAJOR carriers. Are there companies that will cover you? Sure, but they have limited benefits, lower payment cut offs, higher deductibles and smaller participating provider networks. However, the rules change starting January 1st, which means they will start opening enrollment for the new plans in October. That will be the prime time to apply for coverage - these companies will all want as many subscribers as they can get. As the consumer, you won't have a lot of the hassles that many people experience when applying for private insurance now.

I'm an underwriter for individual plans, so I'm the person behind the scenes who is making you do phone interviews, submit medical records, get a current check-up, etc. I totally understand how infuriatingly frustrating getting private coverage can be. The new rules will help an enormous amount of people, and I'm really glad to see the changes!!

I hope that helps. If you have any other questions, I'll try my best to answer them! :)

[Sadtosaygoodbye 256]

I'm sorry I wasn't clear! Let me try to explain...

When I say Obamacare, what I mean really are the new insurance rules, not really a specific plan. Once the new rules go into effect, private insurers won't be allowed to decline anyone coverage. They won't be able to exclude coverage for ongoing medical conditions (meaning, you can't have a rider to your contract saying they won't pay for anything related to, say, a joint replacement you've had, for example) and they won't be allowed to set pre-existing condition limitations on the plans. Also, there will be minimum required coverage - for example, preventative care, check ups, mammograms, pap tests, etc.

So, what I mean is that RIGHT NOW - most people with recent WLS won't qualify for insurance with MAJOR carriers. Are there companies that will cover you? Sure, but they have limited benefits, lower payment cut offs, higher deductibles and smaller participating provider networks. However, the rules change starting January 1st, which means they will start opening enrollment for the new plans in October. That will be the prime time to apply for coverage - these companies will all want as many subscribers as they can get. As the consumer, you won't have a lot of the hassles that many people experience when applying for private insurance now.

I'm an underwriter for individual plans, so I'm the person behind the scenes who is making you do phone interviews, submit medical records, get a current check-up, etc. I totally understand how infuriatingly frustrating getting private coverage can be. The new rules will help an enormous amount of people, and I'm really glad to see the changes!!

I hope that helps. If you have any other questions, I'll try my best to answer them! :)

I just didn't understand your terminology of Obamacare plans. I work in a busy ER and we have been educating our patients on the Affordable Healthcare Act. It was just a case of I say Tamatoe you say Tamato. Thanks!!