I'm Really Scared...

April 4, 2008

I have been getting everything ready to apply, and I just overheard on the boards somewhere that a Kaiser INDIVIDUAL policy would NO WAY include even the option for bariatric surgery and my heart nearly stopped.

The site, the phone...no one will tell me. How will I ever know? When I submit my application and get my heartbroken six months later?

If anyone knows a away to check, please...by all means. I am anxiously waiting to find out if it is even worth my time since I am not under a group policy, thank you.

Kat817 · April 4, 2008

What do you mean no one will tell you? I just called the insurance company and ask what the perimeters on MY policy were concerning weight loss surgery. I then ask that they be mailed to me, and I began crossing things off as I met them.

You pay for the insurance, if whoever you are talking to on the phone will not answer your questions-------ask for their supervisor---ask nicely, but just state very plainly that you are asking specific questions, and not getting specific answers that you need. Keep saying it until you get someone who will give you a definitive answer and be willing to put that answer in writing.

IF you still get nowhere, I suggest finding a way to contact your states insurance commission. If they are going to take your premiums, they have to be willing in advance to tell you what they will and will not pay for.

They cannot bite you over the phone--even though sometimes it seems like they might! Keep pushing til you get your answers.

To be totally honest I would not hold my breath on an individual policy. My DD had an individual insurance policy for awhile, and it covered very little actually. No birth control, yet pregnancy was not covered either! Insurance----boy now there is something that needs re-worked!!!

Good Luck, I hope you get good news!!!

Kat

April 4, 2008

Thanks Kat. My big problem here is I am switching from group policy to individual, so right now I am in the process of being accepted. Because of my weight, I am scared of denial, and I especially don't want them knowing I am looking into the surg, cause that would be a good reason to deny me to save them money! I know there's a huge department there that decides all this...they've denied me once before when my policy lapsed because I used to have galstones.

I wonder if there is a way to contact them anonymously and ask?

When I tried to do that with Humana and Aetna they tiptoed around it like Ballerinas and never gave me a straight answer.

Kat817 · April 4, 2008

I know in a group policy the company can add riders or exclusions to policies, but you should have an website you could go to that will list what the policy covers with all the legalese...

I know I have had to refer to mine and fight it on a maximum out of pocket costs....they did not want to discuss why they were not covering 100%--but a copy of the policy with a slew of unpaid bills....they got paid!

Kat

Wheetsin · April 4, 2008

Find your summary plan description (SPD). You will have (received, up to you if you have) one for your initial coverage. You will receive one for new coverage when you receive your membership packet. It will itemize exclusions.

Vicki J · April 4, 2008

BikinniBeachy - I'm a Kaiser lapbander. I know of one other person who has an idividual plan and got the lapband last October. This is in No. California. What you need to do is call your patient services. They will tell you right over the phone if WLS is covered. I also called my bariactric department to make sure that they did the lapband. For your individual plan coverage Patient Services is the way to go with Kaiser.

Good luck -

April 6, 2008

Thanks so much...I actually got accepted today (yayy!) The packet should be here soon...here's to that! Thanks again....

Vicki J · April 7, 2008

Great!!! Which Kaiser are you going through? Do yourself a favor and set your mind to a long journey. The Kaisers in No. California are taking about 8 months to a year to get through. It is totally worth it. Work the pre-op diet hard and you'll have a great start towards reaching your goal. Then when you get the band not only will your liver have shrunk but you'll also know that goal is much closer and the band will help you keep it off.

Good luck!

April 7, 2008

Let me add first your little baby is such a doll!

And I'm going through Colorado's Kaiser. Packet will be here Wednesday...and I'll keep everyone updated! Can't wait to start my preop diet!

Vicki J · April 7, 2008

Yeah, Reggie's a cutie. I have 7 of them running around my place. It's my husband's mid-life crisis. LOL. Better that than some young thing. I love them all though. I've always been an animal lover.

From what I've heard Colorado farms out their WLS. Is that still true? Hopefully their system will move faster. Keep me posted on how you're doing. I'd be interested in the comparison between Colorado and California, too. (I don't mean that you're in God's country and I'm in the land of smog. <grin>)

Good luck and glad to see you're headed for Bandlandia!

Vicki

April 7, 2008

Vicki...I was just reading old posts and look what I found from you ,

"I am just so excited because I see all of you that have already gotten your bands doing so well. It sounds stupid but sometimes I almost cry knowing that there is an end to this hell."

You sound like me *tears running down my face* and then I look at your 101 down...

Vicki J · April 7, 2008

Boy, that seems so long ago and it hasn't even been a year yet. It's when I realize that that I have to sit back in astonishment. Who would have thought that such great things could happen in just a year. It's nice because not only has it happened to me but I have acquired friends who are going through the same thing at one stage or another. It's nice to see them doing so well, too.

As so many ahead of me have said, "I wish I had had the surgery many years ago." So much of my life was wasted because I couldn't do things. I started telling myself years ago that I was getting old. Well, I've found the fountain of youth I guess because I don't feel old anymore.

You'll be looking back soon and say "that was me". Then you'll look in the mirror and say "No, this is me". It's coming. Sooner than you think.

Vicki