Post Surgery Insurance Issues

[Hoop79088 1]

I am covered through my employer with BCBS. I have been shopping for health insurance for the rest of my family. My employer has agreed to take me off their group insurance and pay for a policy for me, my husband, and son because the cost is very close to what they were paying just for me on the group policy. The problem is that when BCBS found out that I had had the lap-band surgery they would not cover me at all, excluded me completely! Humana did the same thing. Has anyone had this trouble and does anyone know of an insurance company that will cover you (not under a group policy) knowing that you've had this surgery?

[AngieAngel 0]

Something about this does not sound right...Are you working with your HR dept?

[Hoop79088 1]

Well, the problem isn't with the group policy at my work, I am covered there and haven't had any problem, although that insurance wouldn't cover the surgery which is not problem. The problem is with the insurance outside of my work that I am trying to get for my husband, son, and me. I want to be taken off my company's group policy and want to be added to the policy for just my family but won't do that unless I can find a company to take me. Does that make sense?

[EmmaWang 0]

My husband is the main subscriber to the BCBS POS and I am also covered through him. I've had my surgery on 03/09. Before my surgery I called several times to make sure that the surgery is covered. I did the 6 month weight management with my primary doctor, my BMI was 43 before the surgery and I also did the all the medical tests they required. My doctor's office submitted all the medical records, my 6 months weight management proof and a letter from me stating why I wanted this surgery to the insurance. The insurance told doctor's office that if it were out-patient surgery, I didn't need an approval ahead. I called twice to making sue that this is the case. So after the surgery, my doctor's office submitted a claim for $9K to BCBS for payment. I have to mention here that my doctor was in my network last year, but he moved out my insurance network this year. However, I do have out of network benefits (I pay 20%, BCBS pay 80%). I just checked online that the insurance refused to pay a penny of the $9K and in the statement it said that I might be responsible for all the cost. I was very upset. So I called the insurance right away. They said that they couldn't find any medical records related to my surgery. They will send a notice to my doctor's office and ask them to submit the medical records. Before this issue this gets resolved. I think I would still be unsettled and frustrated

[malissa 0]

I understand what you are trying to say/do.

Unfortunately, self-pay or private insurance is extremely hard to obtain if you have ever had any medical issues.

I used to work for United Health Care and the smallest thing would reject the new policy.

To make matters worse - once you have been "denied" coverage, as a matter of policy, no other private/self-pay insurance will pick you up.

Your best bet is to stay with your employer coverage. Are they making you pay the difference for your family?

Good Luck.

[kgloverii 0]

Pre-existing conditions are a bear, and unfortunately, if you can find someone to accept you, you will have to pay exorbitant premiums and/or have anything to do with your lap-band excluded from coverage for a length of time. That is why group coverage is far superior to individual coverage most of the time. I hope the Obama Administration finds a way to level the playing field for people with medical conditions that find themselves unable to get healthcare coverage as an individual. My DH had Type I diabetes and without group coverage is basically uninsurable, even though he's never had any complications.