Purchasing New Health Insurance

[Candle 11]

I have Anthem BC/BS there's an exclusion on my policy too.

I am canceling and taking out an individual plan with GHI (I think they are only a NY company) They cover the band and as long a there's no gap in coverage I'm told I don't have to worry about the weight being a pre-exsisting condition.

I'm not completely convinced this is going to be as easy as it sounds but we'll see in a few months when I finish the doctor supervised 6 month diet and we submit to the insurance company ...

*fingers crossed*

Between co-pays, the shrink and tests not covered by insurance, I'm out about $750 out of pocket. I'm going to freak if GHI doesn't cover it. Plus I'll be stuck with their crappy plan until open-enrollment in Jan for my regular BC/BS policy.

[FocusOnMBM 0]

Yeah I'm with you as far as being stuck on my new (not crappy, but more expensive!) plan until open enrollment as well.

[Candle 11]

Luckily, mine is the same price, so my employer agreed to switch the plan for me but the coverage isn't as good as what I have now. They call it a hospitalization plan. Meaning they cover testing - hospitalization - surgery - etc but not the fee for office visits.

I'm trying to get all the pre-op tests done while I still have BC/BS. LOL!

[FocusOnMBM 0]

That's just it: people who are eligible for group insurance are NOT eligible for individual coverage in NJ--they don't meet the criteria for insurance. Focus, you were misinformed. I just looked it up and one of the MAIN criteria for being eligible for individual health insurance (in the state of NJ, people, I'm only talking about NJ) is NOT being eligible for group insurance. Sure, you may have slipped through the cracks, but when you applied for individual you should have been asked if you are eligible for group.

If you were asked the question about group eligibility, you should have answered yes, and you should have not been permitted to proceed with your individual application. If your individual carrier decides to investigate at some point you might be kicked off the individual plan and have all your claims reversed. Under certain circumstances if you already have an individual plan you might be able to keep it if you join a group policy, but the reverse is never true. Individual coverage is NOT supposed to replace or supplement group coverage under any circumstances.

Things like this happen all the time and you may very well not get caught. I'm just letting you know what the laws are in the state of NJ. Is your company a NJ-based company? Are you a NJ resident? If both of those are true, then what your insurance agent told you is not. (Is the agent licensed in NJ?) What individual policy did you buy that didn't ask if you're eligible for group?

The card says Liberty Plan Access by Oxford. It's a PPO.

[Alexandra 55]

The card says Liberty Plan Access by Oxford. It's a PPO.

The information I quoted above is from the enrollment form instructions for that plan. I think you would be wise to reexamine your situation. The last thing you want is to get stuck holding the bag for all your medical expenses.

[FocusOnMBM 0]

Since I read what you quoted I've switched to Oxford under a group policy not individual. So I'm good.

[Alexandra 55]

Good decision!

Now, on to what's really important: where are you being banded? Who's your doctor?

[FocusOnMBM 0]

Dr. Nusbaum in West Orange.

[FocusOnMBM 0]

I wanted to let everyone know that I was approved for my surgery today and my surgery is scheduled for 5/3/07.