insurance stories

tonyisstillhere · November 11, 2007

hi, i am in the beginning stages of my research for the band and have a consultation scheduled for tomorrow. i've read alot about the self-pay people but haven't heard many insurance stories. i am on cigna right now, and they require a BMI of 40 or greater or 35 with medical conditions. i am at 38 BMI with no documented medical conditions and i am hoping not to have any. i am also at our open enrollment period for my work benefits and have considered switching to united health care, which according to the representative i spoke with only requires 35 bmi and no other stipulations. is that too good to be true? it's a much more expensive program to be on, but it would totally be worth it if i could be covered. they say it will be 90% in network surgeons and 70% out of network. does anyone have any insurance stories? successful or otherwise? what can i expect? i am looking to have the surgery as soon as possible, anyone have an idea on timeline? any input is greatly appreciated!

parrot0927 · November 11, 2007

i have anthem. my bmi is over 40. my anthem plan coveres 100 lbs over or 35 bmi with 1 condition or 40 bmi with no condition. I had my appts on 11/5 and was approved by 11/8. my surgery is 12/3. i have my history/physical on 11/14 and pre-op testing on 11/19. i'm very excited.

good luck!

tonyisstillhere · November 12, 2007

ood luck with everything and thanks for your input!

4jin · November 12, 2007

I have bcbs of Georgia. I am still in the process, but I have documentation of just weight history of 5 years with BMI at 40. My current BMI is 41.5. I do not have any medical conditions besides the weight. I have recently developed asthma but just one episode so they excluded weight as a cause. I contact BCBS as well to make sure. They do only require bmi of 40+ or 35 or less but with at least 1 medical condition.

I was on the same boat as you. I am looking at all my insurance options as we too have open enrollment. I was going to switch over to AETNA but they have stricter policy requirements. I just contact their customer service number and with my employer group ID number I gave them they gave me a written copy of the guidelines/requirements in order to qualify.

Just give them both a call. But it sounds like you have done your homework already. Don't panic....

I was panicking because of the desperation to have this approved but was blocking myself mentaly of gathering good records or making the right choice.

I have since decided to keep BCBS of GA which is what I have had and just pay the deductible of $500. At least it is better than having to be self pay.

Hope this helps.

Motocrossgirly · November 12, 2007

Hi,

I think that may be too good to be true with UHC. I have United Health Care POS Select and had to have a BMI greater than 40 with no co-morbidities.

My BMI is 43, so I was approved for the surgery; but, when I read my health plan summarry document from my hubbys work it definitely said BMI higher than 40.

My advice is to request a copy of the Health Plan Summary Doc that your employer should be able to get you, before you change insurances make sure you check it out carefully.

Best of luck!

jillybeano · November 12, 2007

I am also in the open enrollment stage at work and have a choice between Aetna and United. Aetna definitely says 40 BMI but the guy at United told me 38 BMI!

If I have to gain 15 pounds to be at 40 BMI, I'll do it, but I am going to sign up with United in the hope that 38 is accurate.

Unfortunately, United cannot give me any documentation until we actually enroll. Which stinks.

tonyisstillhere · November 12, 2007

i just got back from my first consultation with the surgeons office and alot of questions were answered... feeling much better about moving forward. all the staff was very confident in the fact that UHC was the way to, over at least cigna. they had nothing good to say about Aetna either. i am having a sleep study done to see if sleep apnea is an issue, which if it is (i don't have any idea) then i will be approved with no problem. if i have no other co morbidities there could be a roadblock. thanks for your stories, i'm learning alot.