The Good News and the Very, Very Bad News

[nebraskahickchi 2]

Well, I have been trying to get this surgery approved through my insurance since February... and have actually been considering it for a couple of years now.

The good news is on July 17, 2008 I received an approval letter from my insurance company.

The horrible news is it may never happen for me. In June I was informed by my human resources dept. that I didn't work enough hours in the previous 3 month period to qualify for benefits. I took a lot of vacation days and downtime due to my health but didn't have the doctor's visits or notes to back it up. I am 330 lbs now, diabetic with NASH (non-alcoholic steato-hepatitis - a liver issue due to diabetes and weight). I also suffer from horrific Migraines.

So... I signed up for the COBRA insurance...

I got the bill in the mail for my insurance shorthly after I got my approval for surgery... $1800... due by August 25th... !!! That is premiums for 2 months at $500 each and $800 due on my flexible spending account that I had already used for medications and medical bills.

Well, that might as well be $1,000,000. =( I am seriously working 30 hours of overtime this week and get paid bi-weekly. I tried to get a loan through my bank, but with my 2 car loans I am maxed out.

I am crushed. I don't know what to do.

I will be eligible for insurance through work again in October or November. However, I spoke to my insurance and asked them if I were to be cancelled what would happen... they weren't sure if the new policy would consider my request for surgery as something of a pre-existing condition or not. They advised I just pay the $1800.

Is there an insurance person that could honestly tell me what to do here? Or a millionaire somewhere that has $1800 in change laying around? I have worked so hard to get this surgery approved. My insurance is Blue Cross/Blue Shield of California. I work for Marriott Hotels.

I also have to come up with $1000 for a downpayment for surgery, however, the approval letter I have from the ins company says it is good until January 1, 2009.... so I am certain I can come up with that in time.

Any words of wisdom? :biggrin:

Carleen

[wannababy 0]

Is there ANY way you can pay that with a credit card, or ANY way possible. Something...? I know it might take a little while to pay off the credit card, but it would def be better than jeapordizing the entire thing, and still is MUCH better than a self pay option. I know people who don't have coverage and have to pay $20000 for the procedure. Plus, really it is only $1000 for the health insurance, the $800 you owe your company for your expenses that they already paid. I know it might seem hopeless right now, but I would try to do anything possible to continue your insurance, for more reasons that just lapband too. Good luck.

Amy

[Chris61 0]

Sorry to here about the set backs. COBRA is expensive. I do not really understand how your insurance works, never heard of not having enough hours to keep it and then having to go COBRA and then back to insurance. I wish you the best of luck with it. Also have not heard about paying back on the flex spending either. Keeps us informed as to what happens. Insurance is a real strange thing. I found out that if I was to get COBRA at my work it would cost 1,500.00 a month and that is with out the dental and eye program.

Chris

[SanDiegoPhotog 0]

You need to look for someone who specializes in labor laws in your area and have them review your contract, your benefits, etc. I have a really hard time grasping a company that says, oh by the way, you didn't work enough hours to have your benefits that we promised you. Vacation is vacation . . . if you earned the time to take vacation, then you don't get penalized for it and it doesn't count against your hours that you need to work in order to maintain your benefits.

If you look in your phonebook, call the county or the city you live in, or call your local legal aide clinics (often run by law schools in your area), then they should be able to help you--FOR FREE.

You need, at the very least, a good understanding of how and why your company did what they did and if what they did was technically legal.

In the meantime, I would suggest begging for or borrowing the money to pay for that COBRA, and then if you find out later that your company was not within their rights to deny you coverage, you can submit for a refund.

At least, that's what I'd do.

[memeluv 0]

I'm not 100% sure but I have always been told that full time employment is based on how many hours you are scheduled to work not what you end up working. Companies have to offer insurance to employee's that work or are scheduled to work 32 hours or more. If you were scheduled to work more then 32 hours a week then you should have been covered. Even if you took sick or vacation time. Vacation time is considered worked hours. I agree with the others I would check into that cause it sounds like your getting screwed. Good luck! I hope that you can prove your job wrong and they have to give it to you.

[StephOinAZ 0]

I'm not sure how COBRA works, but I completely agree, if you worked enough hours to have the sick time and/or vacation time, then that can't count against you! Did they take your insurance payments out of your paycheck? If so, then legally they cannot deny you coverage since you paid for it. It does sound pretty shady. That is very frusterating, I'm sorry you're going through that. Don't give up and make sure you keep fighting for this! Good luck!!

[areellady 1]

If Mariott is union, then yes, you have to work a certain number of hours to qualify. Sorry this is happening to you. I hope you get it worked out. If I had that kind of cash, I would give it to you!! I refinanced my house to get this surgery. We had a lot of equity in it and I am soooo glad we did. My hubby told me the other night, it was the best money we have EVER spent!!!! 1800 dollars is a lot less than coming up with the 13,000- 20,000 it would cost self pay. Do some research. Contact a someone who deals with labor laws. Good luck to you!!!!

[nebraskahickchi 2]

UPDATE: Yes, my surgery was cancelled last year because I lost my insurance due to losing hours... couldn't keep the quota. Mr. Marriott apparently felt sorry for us who lost our ins. due to that problem as he remedied it by waiving the minimum hours worked policy!! So, YAY... I jumped right on that and have $100 left to pay on my downpayment and I am STILL approved!! Should have a surgery date scheduled within the next couple of weeks... I won't have surgery, just the date... and they say it's going to be before the end of the year!!!!!!!!!!! I am soooooooooo, soooooooo excited!!

[paracelsus51 0]

Congrats!

My insurance excludes WLS by my employer's request. It sucks I had to pay on my own. Will be paying for it for years to come. It's sad that a hotel is more progressive than a University.

[nkara 0]

:crying: I'm so happy this is working out for you!

Congratulations on your approval and I hope the rest is smooth sailing for you. :thumbup: