Change of insurance

MyTurn · April 9, 2008

Hi Everyone, I am not sure if this should be posted on the insurance section or here, if it's in the wrong place I apologize. I am in the pre-approval stage of surgery. I have gone to a seminar, had my surgical consult, gone to my PCP and had him write a letter, I have my nutritional consult on Tuesday and my Psych consult next Thursday, blood work tomorrow and my follow-up with my surgeon on May 2nd. I was told that my original insurer Blue Cross of California takes about 3 weeks to approve and then I would schedule surgery for 2-4 weeks. However, my benefits department at work decided to drop a bomb on me today and tell me that they are changing insurers from Blue Cross of California to Blue Shield of California on May 1st:cursing::redface:. Now, in every other state in the country BC and BS are the same...but of course not in California. So, I am just wondering has anyone been approved for surgery with Blue Shield-Spectrum Shield PPO Savings Plan 1800/3600...which is the new plan. If so, what were your requirements for surgery..diet etc? Also, what are the rules for applying for surgery during the open enrollment. I have been devastated all day. I have worked so hard to get this far. It's been a journey let me tell you. Just to have the rug pulled from under me. I wonder if I could tell the surgeons office what is going on and maybe they could try to get me in for surgery before the end of May? Is that the way it works? Is my current insurance good through the end of May? Or does it end at the beginning? All I know is that open enrollment is the month of May. Any help would be greatly, greatly appreciated. I can't seem to get any sleep tonight. :rolleyes: Thanks in advance.

bigpapa2 · April 9, 2008

I am so sorry about your insurance problem. I think you have to till the end of May to make a choose of your plan..But not sure. I kind of had the same problem. my old insurance wanted me to wait and do 1 year at the medical weight loss center before applying for the band. I did 4 months but the 45 minute drive was too much for my pocket with these gas prices. I changed my insurance on April first. I told them why I was changing and what I would have to do to get the band thou them...have you called the new insur.Co. to see what they think about your problem? I got a lot of info from them and changed April first and started finishing my apt. for the band the vary next day. :rolleyes: ... I also have two years of working with Vet. hospital to help me with my process.for the band.

Hope this helped a bit.

destiny79 · April 9, 2008

sorry to hear that, I had this happen to me I had UHC and my company was switching to Aetna who had a lot of requirements, I talk to my Dr and he made sure I had surgery before the changes, because I would have had to start all over, it only took 10 days for me to get approved by my insurance co. from start to finsih it took me 3 weeks (seminar, phyiscal, submitted insurance, approval finally surgery) Good luck

Bandme08 · April 9, 2008

I would talk to your Dr! Sometimes they can "fast track" you so you can have the surgery before 5/1! Just explain the situation, and see if you are far enough along in the preop requirments to be able to do that! Call today!!

jena · April 9, 2008

Talk to the new insurance company or your HR person. There is no guarantee your new insurance will cover it at all!

However...if your insurance is changing, you are, by law, able to be covered under COBRA. If you find out the new insurance won't pay and the doctor can't get you in early enough, Pay for the COBRA for the month and you will be covered under the old plan. COBRA will be more expensive as you have to pay the whole premium, but it is worth it if your new insurance doesn't cover it!

HTH,

jena

gwyllgi · April 9, 2008

Don't worry too much - there's always a way.

The first thing to do definitely is to find out whether or not Blue Shield of CA covers the surgery at all, as jena said. If not, look into the COBRA option! (COBRA is really expensive in most cases, though, so be prepared for a bite out of your wallet. Mine ran almost $600 a month for myself.)

Otherwise, changing insurances doesn't generally throw too much of a wrench into the works. Most have fairly similar requirements for the surgery and what you'd done in the past won't be negated just because you're switching to another insurance; your surgeon's office will just resubmit the documentation of those past appointments, etc. to the new insurance.

Double-check that your surgeon and the facility at which you'd have the surgery are part of your new network, though.

I was on COBRA when I started working toward my lap-band. I was still fighting with them about the surgery when my COBRA ran out on February 24th. February 25th, I updated my insurance with my surgeon's office, and February 26th the surgery was approved. So keep your hopes up! Although switching insurances is a hassle, it's not necessarily as bad as it sounds.

destiny79 · April 9, 2008

it could be totally different UHC only reqiurement bmi over 40 approved, company switch to Aetna requiements 40 bmi 2 co- mobit. 5 year weight history, and a evulation from a psycologist

MyTurn · April 10, 2008

Thank you all so much for your supplies. You guys gave me some great ideas. I will be calling my surgeons office tomorrow to apprise them of the my current situation and hopefully they can lead me in the right direction. I did find out that the insurance that I am getting does cover weight loss surgery, if it is medically necessary...which it is, and my work is NOT excluding it on their plan. They were aware prior to talks with the insurance broker that I was in the process and they asked about the wls coverage and were clear that they wanted no exclusion on the policy. So those are two good things. My main concern is that the dr. and the hospital are out of network for this plan. Well, the hospital is in network if it was an outpatient surgery. My surgeon however requires an overnight stay. I wonder if that is up for debate or not. So, I went to BS web site and he is covered under BS...but just not my specific plan. I wonder if that website is updated regularly and maybe he takes it now. I guess I will know tomorrow if I am able to get through to the insurance specialist at the office. If both the surgeon and the hospital were in network than it would be covered 100%. LOL...I know I am not that lucky.

I went for my blood work today and plan to keep my psych appt and nut appointment in the next two weeks. Just gonna take it one day at a time.

If I had any doubts about wanting this surgery or not....having the thought of it maybe NOT happening....cleared up any doubts.

Thank you again for your support!! Have a wonderful day tomorrow...as it's late and I am sure that you are all zzzzzzzzzzzzzzzzzzzzz. Ciao