Insurance coverage in Florida

[kyrasma 3]

Anyone know of an insurance in Florida I can buy to get Lapband coverage. My husband and I currently are covered by 2 insurance that do not cover this. We have Cigna and BCBS of Florida. What luck huh! I am thinking of canceling both of these policies to get one that will cover what we need. We both are canidates for the band.

Buying insurance has to be less then paying for 2 surgeries! Any ideas????

Kyrasma

[Gary Smithey 0]

That may be the problem. If you don't have group insurance, it's inconceivable to me, a licensed agent in Texas, that any company would sell you a policy so they could lose money. Insurance companies measure risk and avoid them! Groups may have have coverage, individual plans don't have maternity. Why would they do weight surgery?

Their goal when they sign up a client is the same as AT&T, or your dentist. They plan to make money on you. They won't offer you a plan that starts out to lose money.

[kyrasma 3]

Well my husband and I do own a small commerical cleaning business that he runs in the evenings. If my husband goes full time we will not have coverage from his employer any longer and we could look into buying a company policy, Right now we are listed as the only 2 employees. How could that work for us?

[Maitai 0]

Hi,

From what I've heard the weight loss surgery portion of insurance is an option that companies can buy when they offer insurance for their employees. You should call your insurance and see if they offer this option with their coverage. If they don't, then maybe you can talk to your Human Resources office and see if they would allow you to get a rider for your policy that you can pay for yourself or maybe even they might offer to pay for it. Anyway, that was something that was explained briefly to us during our original seminar when they discussed ways to pay for the surgery. During the seminar they encouraged everybody to call their insurance and inquire and find out if our particular policies covered WLS.

So I don't think it really depends on what insurance company, but I believe it depends on what kind of coverage you have. And some companies have the WLS portion excluded as a benefit they opt not to pay for.

GOOD LUCK!

[Gary Smithey 0]

Maitai, in Texas, individual health plans (these are different than group plans) do not offer such riders. Group insurance plans may or may not opt for such coverage. Group insurance is given as a "benefit." It is another way to pay employees to work for them. So, if a company has the weight loss option in their plan, they are trying to give a very good benefit to their employees. Many plans don't have the option because they don't want to spend more on their employees, short sighted as that may be.

In the individual plans in Texas, weight loss surgery is excluded, and some other things are as well. There is no rider I have ever heard of to add weight loss to an individual plan.

The individual health market exists to make money for the company's stockholders and limit risk to those they deem insurable. If you and your "health conditions" fit their idea of reasonable risk, they cover you. They may rate you up in cost or eliminate coverage with a waiver. Everyone else not fitting the model gets declined.

[kyrasma 3]

I am in Florida, not Texas. Do you think it is they same here?

[Gary Smithey 0]

I know nothing of Florida insurance laws but just think about it. Who wants a new client that costs them money, in any business. If that was true, individual plans would let a pregnant woman sign up for $100t to $200 a month (you make up the amount) and cover a $10,000 pregnancy. Pregnant women, diabetics, those over a certain weight, etc. are consisitantly denied by all the big name major med companies in Texas.

What company could stay in business taking on clients that drain their profits? So the idea that one could sign up for a "weight loss surgery rider" on an individual plan, seems unlikely to me in all 50 states, but I don't know all their laws. Insurance companies do not exist to be charitable or to solve your problems. They run a business and their CEO will get fired if he doesn't generate a reasonable return to stockholders. No different than a football coach or corporate leader.

[linda7 0]

I just talked to a lady yesterday that had lap band surgery and her insurance was cigna. And now her daughter is having it. We are in Florida. Good luck

[Gary Smithey 0]

Cigna is a group insurer. Of course group insurance can cover weight loss surgery. I know I'm counting on them approving my case soon.

The original question was posed by a woman who was looking for "individual" not group coverage.

In group insurance, risk is based on the total group. 50% or more of the true cost of the employee's insurance is usually covered by the employer. A generous package of benefits is usually included. It is a form of pay to the employees. Individual plans are much different, with the client having to qualify for the plan (get approved by the underwriting dept.), and pay the monthly premiums all by themselves.

My point is that it is highly unlikely that any state will have a major medical policy sold to individuals (individual health insurance) that will have a rider for weight loss surgery. If you find one, post their name here.

For this same reason pregnant women, without group insurance, can't call up companies after they are pregnant and get them to cover the cost of their pregnancies. It would cost the companies a lot of money and they are not interested in taking on clients or making provisions that guarantee them a loss.

[Gary Smithey 0]

Oops! Back at the top of this series of messages, the lady says she has Cigna and it does not cover weight loss surgery. Cigna doesn't have individual plans in Texas so I never see them do "individual health" cases.

It would appear in Florida, Cigna has both group and individual coverage.

Just like maternity, the best way to get this covered would be to get a job with a company large enough to have group insurance and specifically, have a plan that covers weight loss surgery. Many group plans don't cover weight loss surgery. It is an additional cost (and benefit to the employee) and not every company sees the value of doing it.

[kyrasma 3]

I am not sure what all the talk is of individual plans. The 2 plans we have are both group plans and if we purchased a plan it would be through our business.

[Gary Smithey 0]

I don't think I misspoke pointing out there are two kinds of plans. If you have the option to add it, do so.

Your post did not make it clear which kind of plan you had. Many people that own their own business are on "individual plans" so it's not a lock that business owners all have group coverage.

[AMLP 4]

I live is Ft Myers Florida. My husband works in Naples and his employers cover both bypass and lapband surgery with some conditions that have to be met prior. I had to call the number on the back of my card to ask if it was covered. They said yes, they'd pay 80% and sent me to the website Health Insurance Offered by EmpireBlue to look up the policy regulations. I typed "lap band" or "gastric bypass" in the advanced search box and found it. My only concern is I only have a BMI of 38 and you;re suppose to be 40. Plus they say you have to go on a 6 month Dr. approved diet... which I may lose even more weight... so I may not even qualify after going through all their rules.

Amy

[kyrasma 3]

Who does he work for I am going to send my husband over for a job LOL..... we live in Naples. Where in Fort Myers are you?

[AMLP 4]

Hi again,

We live in South Fort Myers near the airport. My husband works for an aerospace company called Parker. I'm going to my first seminar about the lap band on May 8th, that's suppose to tell all I need to know, meet the Dr. etc.

Here's my email address if you'd like to stay in touch amypep@comcast.net

Amy