asked HR to add coverage to policy... no go!

[amanda2008 0]

This is what they sent me...

Here's the bottom line. Unitedhealthcare is probably not going to add this rider for a group your size. Even if they did, every participant would share in the cost increase in order to allow this person to get this surgery. Every insurance carrier excluded weight reduction services.

We cannot do this rider, as it affects everyone's premium. Hope you understand. Sorry that it can't work out.

I agree it isn't fair that everyone would have to pay more just for me...

Can I get private insurance with coverage for this?

:help:

[Ozzy&OdiesMommy 0]

I'm confused about this. I called my insurance company today to see if they would cover this surgery. The insurance is through my husband's work. There is an exclusion on the coverage for ANY bariatric surgery. Is this something a company intentionally excludes? I'm interested too to find out if you can purchase your own coverage for this.

Thanks!

[amanda2008 0]

yes, apparently if it's totally excluded, it's excluded NO MATTER WHAT. It would be like trying to get the insurance to pay for my glasses when I have no coverage for vision.

[Ozzy&OdiesMommy 0]

But is my husband's job the one who is setting the exclusions on the policy?

Thanks!

[amanda2008 0]

Yes, the company chooses the plan it wants to pay for. I know some companies have "open enrollment" where you get to choose what you want but we don't have that at my company (which is small, like 10-15 people).

[Ozzy&OdiesMommy 0]

Ugh! I'm in for a long haul I think. My husband's job offers 3 different plans. We have the best one and it still excludes it. So, I'm with you, can you purchase private insurance to cover it?

Thanks SO much for your response!

[amanda2008 0]

I'm asking too...

anyone know?

[amanda2008 0]

another question regarding Medicare?

It seems like Medicare will cover the procedure if it is necessary and doesn't have any BS exclusions.

Is it possible I can qualify for Medicare, even though I already have insurance through my company? My take-home pay is less than $1,000 a month.

[Kat77 0]

Medicare is for people age 65 and over unless you are disabled , maybe you are thinking of medicaid which is based on income.

[amanda2008 0]

Yes, I was thinking of Medicaid. I don't know if I am eligible for that though.

[Alexandra 55]

I doubt very much that any state permits individuals to buy additional insurance to cover what's excluded by their employers' policies. I know in NJ it's not even possible to buy individual insurance AT ALL if you're eligible to be covered under a group plan. But check with your state's department of insurance to find out what the regulations are in your area.

Exclusions are a bitch, but definitely check ALL the writing in your policy to see if treatment for morbid obesity is excluded. Often there will be a caveat to the exclusion to the effect that IF you are medically qualified, treatment will be covered. In other words, they won't cover treatment UNLESS you have a BMI of 40+ or 35+ with accompanying comorbidities.

I think the day is coming when across-the-board exclusions of treatment for morbid obesity won't be permitted. But it's not here yet.

[Ozzy&OdiesMommy 0]

Thanks Alexandra. When I talked to the insurance company yesterday it said that no bariatric surgery was covered whatsoever for any reason. But in looking at the benifits package last night they do offer coverege for weight loss programs. Do you think that's worth exploring? Could lap band surgery be considered a "weight loss program"? It said it can cover gym memberships, excersise equiptment and other things. I guess it kinda chaps my @ss that insurance would pay for that stuff (which I've already tried and paid for out of my pocket) and they won't pay for a surgery that is more likely to be effective. Oh well. I guess I need to try and look into the "weight loss program" option. See if I can force it through there?

THANKS!

[Alexandra 55]

Sorry, Ryan, that's really not the same thing. What they're probably offering is reimbursement for gym memberships or things like Weight Watchers, which is just an added benefit and not medical insurance at all. It's one of those "value added" things that the carrier or vendor throws in (since they know relatively few people will take advantage, and it's low-cost even if they do) to make it seem like the company is getting a great value. It really has nothing to do with coverage for medical conditions.

[Ozzy&OdiesMommy 0]

Well that sucks! My husband was just reading things to me last night out of the information they sent us. So, I didn't actually look at the coverage. I'll figure something out. Someone on the General board suggested a DR in Denver. That might be worth looking into.

Thanks again!

[amanda2008 0]

Can you ever overcome exclusions (via avoiding other surgery?)

WLS is (but of course) excluded from my insurance (United Healthcare).

However, I have a chronic back problem and now a knee problem caused by a rotated pelvis that is not going away despite two years of physical therapy, and will likely be alleviated by losing a lot of weight quickly. The pelvic problem also prevents me from exercising normally (making it difficult to lose weight by normal means).

If the doctor signs off that the WLS will avoid me having back surgery and eventually knee surgery, do you think I have ANY chance of getting UHC to pay for WLS?

You would think the insurance company would be smart and see the cost benefits of avoiding much more costly surgeries with an inpatient stay, but after reading all these stories of denials, I wonder.