Insurance & WLS ....

[ChristyAZ 87]

Not sure if this will help anyone however I thought I would share how I got my surgery covered when it was excluded from my group policy through my work.....

My group policy was a total wash. They said covergae was excluded and medical necessity or not, no coverage. So, when open enrollment thru my work began, I went through an outside insurance broker (you can't go through the Obamacare exchange if you are eligible for a group policy through an employeer or spouse's employeer but you CAN get your own individual policy) ...... I found a full "Individual Policy" thru another big name insurance provider, made sure that the policy I chose had bariatric surgery coverage and signed up then turned down my companies group policy during open enrollment. I now pay for my coverage out of pocket (I really only pay about $60 more a month then if I had my ins thru work since they are not taking my premiums out of my check), have full benefits from a big name company and I get to have the surgery. I was worried at first but from what my broker told me, bariatric surgery does not have to be included on group policies for companies with numbers over 50 (employees) however "individual policies" HAVE to cover, even if they make you do the 6 month diet/nutrician program. Not sure how accurate that is but hey ..... never hurts to check it out .... I plan on keeping this policy till next open enrollment then going back to my employeer offered group policy because a group policy has no exclusions so any "issues" or needs that crop up following my WLS will be covered ..

Edited April 5, 2014 by ChristyAZ

[smokenhaze 9]

which individual policy did you go through? I mean which company did you chose that covered the surgery?

[ChristyAZ 87]

which individual policy did you go through? I mean which company did you chose that covered the surgery?

I contacted an insurance broker in my area that delt with medical policies and he gathered all the information for the top 4 companies in my area. I asked for desriptions of the policies and what was and was not covered. I did have to pick a top tier policy (a Platinum policy) and I pay out of pocket every month but I don't pay for my group policy at work so it did even out for the most part. I chose BCBS and the plan I chose covers the sx if I met the guidlines and I did .... I completed the requirments and now I ma scheduled. I do have a $1000 bariatric surgical fee but I can live with that ...... hope this helps ...