Best Insurance Coverage in NYC / No wait times?

[CurvyNYC 0]

Hi,

I hope you can help me choose an insurance plan that will allow me to undergo LapBand surgery without requiring a 6 month waiting period.

Luckily, I run my own small business (very small business, actually, with one employee) and I have the freedom to choose most insurance plans (either a business group plan or individual, depending on which will net me the best coverage).

I haven't selected my 2014 coverage yet because I have spent the last 2 months researching WLS options, surgeons, and financing and was afraid of locking myself into the wrong plan. None of the insurance agents I contacted were helpful. The most they could tell me was to contact the providers themselves who would not give me access to the fine print until I became a cardholding member. The same goes for potential surgeons -- none of them would recommend a specific insurance until I became their patient, and to become their patient, I need to acquire insurance! So it's a never ending revolving door...

I finally selected a surgeon and a plan she accepts that I thought would be the best option: United Health Care \ Oxford. But then I discovered that there would be a 6 month minimum wait, so I didn't purchase the policy.

The thought of waiting 6 months in my present condition + the fact that 6 months from now will be a very hectic time in the business is very discouraging (and it only gets busier until the end of the year).

I know I can always make excuses as to when is a good time but I feel I am super ready, so now or even 2-3 months from now is ideal.

My BMI is >35 (but under 40) and I think I can swing 2 comorbidities (or at least one).

Questions:

1. Have any of you recently (in 2014) had Lap Band surgery with United Health Care in NY? Was there a waiting period?

2. Which insurance would you recommend as providing the quickest application approval in NY? I don't have a lot of spare cash to burn but I'm still willing to purchase a more expensive plan to avoid the wait.

3. I have a history of weight loss failures, but not "officially" documented. Any suggestions?

4. Any surgeons in the NYC area who are sympathetic and will rush an application along?

Thanks in advance!

[2muchfun 8,927]

I'm far from NYC but I'm somewhat familiar with how insurance plans operate. Did you check to see if the United plan had bariatric coverage? Every carrier will have to disclose what is covered in the policy prior to signing on otherwise they'd be opening themselves up to a lawsuit for non-disclosure.

I would imagine that all carriers will require the 6 month wait or may not offer bariatrics or any other elective surgeries due to the fact you could have the expensive surgery and cancel the next day. Follow the money with insurance and it will make sense to you.

It's not like group plans where they factor into the premiums the costs of people entering and leaving the plan. People really do have elective surgery and bail soon after, leaving the carrier with a $10K debt and only a few months of premiums. Not saying you're going to do this, but it is a factor when the carrier is offering a plan. jmo

Good luck.

tmf

[CurvyNYC 0]

The United Health Care plan (I'm referring to Oxford which is only available for small business groups) covers everything, and the best surgeons in NY accept the plan. I can purchase it through my business for a small ransom (10k a year for a single plan!)

I'm stuck on the 6 months wait period though. The insurance is already so expensive and I really cannot afford to wait. Any tips? I am looking for any method to get the required documentation.

[2muchfun 8,927]

I'm no help. I've always had group plans and now I'm on Medicare. My surgery was covered through Capital BCBS www.capbluecross.com and it was covered. Initially they required a 6 month nutrition/doctor plan and right at the end of that plan changed it to no 6 month plan. But, I'd already went through the 6 month period so it was a no brainer after that.

Good Luck

[gowalking 10,790]

I had my surgery at NYU and have cigna. Couldn't get around the documentation required. It was three months under a doctor supervised WL attempt.

[kimk1999 450]

I'm in Florida under a group plan with Cigna. Like the previous poster I had a 3 month physician supervised diet. Two weeks after that I had my surgery (I was worried it wasn't going to be approved on time).

My history - 35 BMI at surgery date (shhh I didn't dare lose a lb on my 3 month plan). Plus at least 1 comorbid condition.

[kimk1999 450]

Any previous weight loss attempts documentation was my word against theirs (as far as I know of)... It was all hand written down when I tried diet / exercise, ww, HCG, B12, etc... Lbs lost and gained back.

For the record I was banded Dec 2013 (6 weeks post op)

[CurvyNYC 0]

If I wasn't insured during this supervised weight loss program, will that be a problem?

Must the 3 months / 6 months be under your current insurance program?

If I purchase insurance tomorrow and put the paperwork together (all the pre-op tests, proofs of BMI with comorbidities, etc. + weight loss program from the past) will I still have to wait?

Thank you so much for your feedback; no insurance agent will help!

[gowalking 10,790]

All I can tell you Curvy is that I went to the seminar in June of 2012, and was approved in September. Made the appointments with the other doctors to confirm no psychological issues, no heart issues, etc. Got the date for late October...and then Sandy hit. NYU was affected terribly and I had to wait till January of 2013 for the hospital to be performing surgeries again. So...just know that anything can trip you up...even with the best laid plans.

Can I ask...what is the dire hurry? Many bandsters or other WLS patients can wait a year or more just to get a date. There can be more to getting approved than just documenting the weight loss attempt. If the doctors find an issue with anything potentially being a risk they didn't take into account, you may see a delay.

[kimk1999 450]

This is just my guess as I'm not a doctor or insurance person... My physician who supervised my diet plan filled out a form from my surgeon at each visit. Recorded my weight and other crap and talked about what I was going to try to do this month coming up. I don't think you have to have insurance pay the doc part. My surgeons office offered the medically supervised diet plan too and they don't take insurance for that "program" but it would meet the insurance requirements.

[CurvyNYC 0]

Thanks everyone; I feel more at ease now that I have a plan going forward.

[toothfairy86 23]

I have United Healthcare Oxford, approved on first letter. I had a very good surgeon from Connecticut. Dr James Bonheur. He is so good..

[briefs199 337]

I have Empire and they required 4 months of supervised weight loss but I did it through the surgeon's office at NYU.

[cryssyd3 80]

I see this is an old post but I live on Long Island. I had tricare and just switched to fidelis/ Medicaid and there is no wait time.

Edited September 27, 2014 by cryssyd3