OMG, shopping for new insurance and we're denied because we had lapband surgery!!

I just got a call from our insurance agent. She's been shopping new health insurance for us. We're self employed and our rates are going up BIG TIME. We PRIVATE paid for our lapband surgeries ( me an my hubby ) so insurance wasn't involved AT ALL. In applying for NEW insurance we answered our paperwork honestly and listed that we had our surgeries in July. Our agent was shocked that every insurance company she's talked with is denying us now due to having lapband surgery!!!!!!!  How crazy is that??? I guess they're OK that my hubby USED to have high bp before the surgery or with old higher weights, but they see the surgery as something to deny insurance coverage??? We have NO clue what we're going to do!!!!! I work with my hubby and may have to change jobs JUST to get us decent health insurance. Has this happened to anyone else who's self employed???? OR can anyone who's self employed recommend an insurance company who doesn't decline coverage for this????? At this point our ONLY choice seems to be the HORRIBLE state CHIP plan that's for people who cannot get coverage anywhere else. Basically it just covers us in case something MAJOR happens. It's either that or we pay $2000 a MONTH to stay on our current plan!!!!! NO can do! My agent said she had NO idea insurance companies denied for lapband surgery. Does anyone have any suggestions???? Thanks so much!!!! :) Melissa

That is aweful!  I don't have answer for you  but I sure hope someone on here can help.

Thanks, Amy. I hope so, too. I've asked our agent WHY our insurance company can't just EXCLUDE anything with the lapband and call it preexisting. She's just been given flat out denials. She told me that gastric bypass clients are denied by insurance for 5 years and she's trying to find out what their "rule" is for this. I swear people who are obese are damned if they do and damned if they don't. I'm going to press her for a clear up answer about this "rule" all the insurance agenices apparantly have and ask WHY they won't just do an exclusion. Does anybody out there have any ideas??? I need um! :)Melissa

While I think it is descrimination and wrong, I do understand why insurance companies would not want to cover lap band patients. Lap band is different from ALL other weight loss surgeries in that risks of complications go UP with time (due to the foreign body present inside your body).  All other weight loss surgeries major complication rates go down to next to nothing after 18 - 24 months.  When I'm talking about major complications rates, I'm talking stuff that requires more surgery, not stuff like vitamin deficiency and dehydration.  Study after study has shown this and recently the American Society of Bariatric Surgeons published a study which said that not only does lapband fail approximately 35% of the time, but that the reoperative rate for lapband patients is higher than that of gastric bypass when longterm results are taken into account.  Taking that into account, then adding in the costs of lapband fills/withdrawals, as well as longterm probability of band erosion, slippage, ulceration, and other major complications requiring further surgeries, I can understand why they wouldn't want to cover you. Please don't think I'm agreeing with them.  I am not.  I think it is wrong and discrimination and I do not think that they should legally be able to do it anymore than they should legally be able to deny former smokers because they MIGHT get lung cancer one day.  It's ridiculous.  All I'm saying is that I can understand it. 

The bottomline is that we private pay for ANYTHING lapband related. Our agent said that insurance companies decline gastric bypass patients from having insurance until 5 years after surgery. My surgeon would disagree with the stats you listed. But regardless, if WE private pay for any complications or need to have our bands removed at any point that's OUR cost. Do insurance companies deny people for having boob jobs? haha Nooooooo. But, there IS a risk the implants could leak and cause problems, etc. I know you're not agreeing and all of this sort of discrimination is wrong. But, if you private pay and ask for an exclusion so that if ANYTHING happens that's lapband related YOU pay for it, not the insurance company......what is the big deal? I really don't get it.

You have to understand though, that last year insurance companies posted RECORD profits. The fact of the matter is, they don't have to take the time to write policies that help people.  They write policies that screw people all day long for whatever outrageous reasons they can think of and make RECORD PROFITS doing it. Why would they want to risk you possibly trying to challenge an exclusion later on when they don't have to? I'm not trying to be cold, I'm just saying.  Insurance companies are right up there with lawyers in my book.   I've heard of insurance companies refusing to insure gastric bypass patients for 2 years post-op, but not 5.  This makes sense too because most complications with gastric bypass occur within that time period. Considering that lapband complications rates go up over time, I wonder how long they will deny to insure you?  Did she at least have a window?

Hi again :) Oh I agree insurance companies are THE WORST. My agent has never heard of this and is going to find out tomorrow what the time restriction is for insuring someone with a lapband.  I've had others tell me off the record that they've just left it off insurance forms and never had to report anything to make sure they get basic coverage. Our fills are paid for 18 months. We private pay and if we have a problem we'd private pay, too. I guess we just shouldn't have been honest. haha

At some point I'll just have to stop working for my hubby and get a job to get  insurance. It doesn't matter when you're with a big group. They risks are evenly distributed. But, in the meantime this pretty much sucks! I'll post what I find out about the time limitations from my agent once I know. As for not doing an exclusion, insurance companies do this for other conditions. ALL our blood work is great, no high bp, no diseases, NOTHING but seasonal allergies like everyone who lives here. haha I guess we just should have done what others have done and left it off. UGH ( and yessssss I know insurance companies can come back and remove your benefits if you withhold info, but if no one knows why would they? )

Thanks, Jodi. I'll do that and see what I can find out. My agent said she doesn't know of any insurance companies in Arkansas who pay for lapband surgery. So, I'll check out the boards and see if I can find out more info. She said insurance companies are telling her they consider lapband like they do gastric bypass and deny coverage until at least 5 years post-op. She's going to talk with an underwriter/manager about a written exlcusion for the lapband, but we both doubt they'll do it. They don't care. I've had others tell me they just excluded this from their application to get insurance. She warned me that even when you private pay it's all reported to a clearinghouse and all any insurance company has to do is pull those records and they'd see that you withheld info. THEN, they come back and make you pay for anything they paid for, etc. SO, not a good option even though that's how some people have dealt  with it. I have no clue what we're going to do.

I would post this question over on the Lap Band forum and see if you get any answers over there.   A lot of smart people on that board with a lot of experience. Charlet