Illinois Health Insurance Exchange - Obamacare Coverage

[UpandAtom 126]

Hi, I am hoping someone can help me. My work insurance has a specific exclusion for ANY weight loss surgery or programs. Not covered, no way no how. I thought I would buy an Illinois Insurance Exchange plan because they all cover Bariatric surgery as required by the state of Illinois. Unfortunately, since my work offers an insurance plan, an exchange plan for me and my family is too cost prohibitive - like $1300 a month or more for a good plan. What I am wondering is: if I buy an ADDITIONAL exchange plan just for myself, while leaving my work coverage in place, will the exchange plan likely cover the procedure?

I had read somewhere that if a "primary" plan excludes coverage, then a secondary plan is likely to as well. If anyone has done this or otherwise knows anything or has any advice, please let me know!

Thanks

[ThreeFifty 166]

Im not sure if its suppose to work this way, but I was same boat. My work ins didnt cover wls. I went and got another primary ins (obama care - no income based discount) and used that instead. the premium was high, the deductible was high but it covered my surgery and all other visits.

[nicole91379 2]

Did you still keep your employer insurance as well

[UpandAtom 126]

@ that is exactly what I want to do! I am thinking that since my state requires WLS as a medical necessity that the insurance exchange should cover it. What state are you in?

Nicole, I have to keep my work insurance so that my wife and kids have coverage. I can not afford a family plan on the exchange.

Do you think I should call someone to ask? I am a bit afraid to tell them I'm buying specifically for WLS in fear that they'll deny me or jack up premiums. Like King David I will not get any discounts or special considerations for income level.

Be blessed!

[nicole91379 2]

@@UpandAtom I'm not sure, I have to keep my insurance for my kids as well so I'm looking at $468 +$385 through insurance exchange. I still haven't heard from the surgical office that plan I mentioned above is a HSA, I'm afraid to ask as well. All my preoperative appointment are done as of today

Edited December 23, 2015 by nicole91379

[nicole91379 2]

@ did you keep both plans and was it just you on the employer plan?

[ThreeFifty 166]

I kept both plans, was just me on both. got rid of the Obamacare plan when the year was over. but yep I kept both insurance and just gave he Obamacare ins info whenever I had bariatric visits or procedures. continued using my work ins for any other visits.

[nicole91379 2]

Ok thank you

[diane1 26]

How much was the premium of you dont mind me asking kingdavid757. Which insurance did you purchase? What was the deductible?

[OutsideMatchInside 10,166]

Why the time you pay for a whole year of premiums and out of pocket, it would be cheaper to just go to Mexico, or to Blossom Bariatrics in Vegas.

[ThreeFifty 166]

yea if you include all the other visits, seeing the nutritionist, Phsycologist, the random doctor visits, having an EGD etc it would be cheaper to just go to Mexico, where you aren't going to have all those extra's

But

If you only counted the insurance premium, and deductible for the actual surgery. it would be about the same as plane tickets and surgery in Mexico. and no offense to people that has gone to Mexico but if I have the option to go to a local doctor in the US, in my city that I can always make an appointment and see, that I can research legitimately (not asking forum users opinions). then for me this option was more suitable than the option to go to Mexico.

Don't get me wrong, if this option didn't work, Mexico was next on the list. but because of what I listed above, the Mexico option was further down the list...cheaper or not

[OutsideMatchInside 10,166]

Just because you have a surgeon in the US doesn't mean you will be seeing that surgeon long term. A lot of them pass their patients off to PA.

Even if you don't go to Mexico. you can get a cash option in the US cheaper or about the same as what you are going to spend on double premiums, out of pocket etc.

[nicole91379 2]

Just because you have a surgeon in the US doesn't mean you will be seeing that surgeon long term. A lot of them pass their patients off to PA.

Even if you don't go to Mexico. you can get a cash option in the US cheaper or about the same as what you are going to spend on double premiums, out of pocket etc.

I called my provider who states 24k at one hosp 27k at another...no where near cheaper ????

Sent from my SAMSUNG-SGH-I337 using Tapatalk

[ThreeFifty 166]

Yea mine was about 19k for the surgury alone, 2k for the full bloodwork, which they have ran 2 times during this whole process, a few K for the EGD, and about 360 per visit for about maybe 6 or 7 visits throughout the year for different reasons. cash option isn't cheaper by any means lol even if you just count the surgery alone, its well over double what I paid in premiums/deductible

[OutsideMatchInside 10,166]

Asking your provider (insurance provider?) or asking the hospital what their cash price is? These are 2 different things. My surgery billed at 38K but the insurance agreed rate was under 12K (what BCBSIL actually paid). A lot of hospitals in the US offer cash prices in the 11-12K range.

http://kcbariatric.com/compare/

http://www.hoab.org/procedures/gastric-sleeve-st-louis-mo/

I believe someone who posted on here said blossom was 10K and that was in 2013.

http://www.fox5vegas.com/story/27844392/blossom-bariatrics-at-the-forefront-of-low-cost-weight-loss-surgery

Everyone has to make a choice that is comfortable for them. You don't really have to have long term care from your surgeon, you can do your follow up care with your primary.

If cost is an issue, there are lots of avenues to explore.

Depending on where you live in Illinois a BCBS single plan is going to cost you around $300-500 or more a month for one person (it varies by age and county). I think the lowest out of pocket max on a plan is $4500. So premiums and out of pocket are going to be 7500-9500 alone. Might as well cash pay, because you are basically cash paying at that point anyway. Unless you have your heart set on using Northwestern or University of Chicago, I don't see any other center in Illinois being worth the cost and hassle of insurance.

Edited January 4, 2016 by OutsideMatchInside