Switching Insurance

[SandeeD 363]

Hello everyone! My story is a looooooonnnnngggg one, but I'll cut to the chase. I've been with Horizon BCBS of NJ since April 2013 (it's an individual plan that I pay for myself). It's bare bones and only covers well care stuff but no pre-existing conditions. Fast forward to now, I was able to get the bulk of my pre-op testing done with my insurance covering it. I just have a few more things to square away the first week of January. Because of the pre-existing condition clause, this plan will not cover my sleeve surgery until I've been in the plan for one year (April 2014). In the meantime, because of the new health care laws, Horizon sent me a letter stating that my current plan is being canceled as of the one year anniversary date in April 2014 (they're phasing out this plan because it does not abide by the new healthcare laws). So, what all of this means is that I will need to switch insurance plans before applying for approval for the sleeve surgery. Again, I'll be done with all of my pre-op requirements the first week in January 2014, but I need to have my new insurance in place before submitting.

MY QUESTION IS, HAS ANYONE HERE SWITCHED INSURANCE PLANS (WITH THE SAME COMPANY), OR SWITCHED INSURANCE PLANS (USING A DIFFERENT COMPANY) AND HAVE BEEN SUCCESSFUL GETTING APPROVED??? WILL THE INSURANCE COMPANY PENALIZE ME BECAUSE THE POLICY IS SO NEW??? (IT'S NOT MY FAULT THE INSURANCE LAWS HAVE CHANGED). WILL THEY MAKE ME WAIT? (THEY CAN'T TURN DOWN PRE-EXISTING CONDITIONS ANYMORE, RIGHT?).

ANY INSIGHT (BASED ON EXPERIENCE) WOULD BE GREATLY APPRECIATED!!!!

THANKS A MILLION!!!

[dreamscometrue 262]

Hi there! So, I'm not sure if this will help you or not.... But I'm kind of in the opposite position you are in... I currently have UnitedHealthCare and they have been AMAZING! I have it through my company, and they approved the sleeve within 2 days of it being submitted and covered 100% cost for the surgery. As of January 1st, I will be switching to Horizon of NJ and they seem to be very specific and more challenging on coverage for this surgery... Basically, more hoops to jump through. If you have a choice of what insurance to look into, I would highly suggest taking a look at UHC. Any insurance will be very up front with you about what they will/will not cover before you sign up with them. Good luck to you! Insurance can definitely be frustrating... That's for sure!

[dreamscometrue 262]

Oh, and I meant to tell you that with UHC, there were no hoops to jump through. No 6-month supervised diet, no 3 years of records from primary care physician, etc... That would obviously vary depending on which plan you choose, but if it were me, I would opt for the most coverage as possible to get the best coverage for your surgery. You don't want to end up with a $15,000 bill because you opted for a cheaper monthly bill. You could always drop down to a lower plan in another year!

[SandeeD 363]

Thanks Dreams. My real question is lets say I switch to United Healthcare effective 1/1/14, and I've already fulfilled their requirements and then some (over the past 3 months while I had Horizon BCBS of NJ) will they give me a hard time approving the surgery because I am a brand new customer???

[SandeeD 363]

Ok, all set with insurance. I decided to stay with Horizon for 3 more months. I switched to a new 2014 plan that cost more but it would approve me for the surgery (no exclusion of pre-existing conditions). I didn't want to switch companies altogether and risk possibly not being approved. I will apply for a healthcare subsidy before the 3/31/14 deadline and hopefully get my premium reduced. In the meantime, as of 1/4/14 I'll be all done with my pre-op appointments. Money will be tight but it's all so worth it:)

[dreamscometrue 262]

Ok, all set with insurance. I decided to stay with Horizon for 3 more months. I switched to a new 2014 plan that cost more but it would approve me for the surgery (no exclusion of pre-existing conditions). I didn't want to switch companies altogether and risk possibly not being approved. I will apply for a healthcare subsidy before the 3/31/14 deadline and hopefully get my premium reduced. In the meantime, as of 1/4/14 I'll be all done with my pre-op appointments. Money will be tight but it's all so worth it:)

Ahh... Just now saw your response! That is GREAT NEWS that you can keep your insurance for the next three months. You are right, it will totally be worth it! I know that even if I was ready to go with surgery, and then I couldn't get a date until after January 1st, I would have had to start from scratch with all new requirements of the new insurance. I definitely think you made the right decision!