WARNING...INS RANT!!!!

OMG! my husband's ins, BC/BS, well, I should say our OLD ins...his employer decided to F*** with the group coverage this year. They changed the way the plan is to that they pay NOTHING until a TWO THOUSAND dollar deductible is met by every family member! NOTHING, ZIP, ZILCH NADA, a big FAT ZERO! They no longer pay dr visits, health checks, immunizations, well baby, prenatal, PRESCRIPTIONS.... NOTHING! you have to first meet the 2000 dollar deductible for whichever person you are trying to make a claim for, and THEN they will only pay 80%! They also raised the premiums. So, we made the switch to MY employers ins, AETNA. I was told by HR that they will have to pay for anything realted to my WLS because of HIPAA. I will get a hipaa certificate requiring them to since I was fully covered by BC/BS for 2.5 years. The main thing is the premiums are very high, but we only have a 25 dollar copay for dr visits, and 10 dollar copay for prescriptions. the upside, this plan also includes vision...pays for the exam, AND up to 200 bucks toward glasses. Has anyone tried to get them to pay for plastics? I KNOW I will be getting my arms and stomach done within the next 16 months. Talk to you later! Tracie

Sorry wish I could be of more help, but I don't know a thing about Aetna. My hubbys compnay has also made us switch insurances....I am not sure of our deductibles or anything like that tho......I still haven't recieved a book of coverage or anything like that, just my new cards! The new insurance won't cover WLS in anyway shape or form as to what I hear~John Deere! So I will know longer be able to go to the U of I for follow ups But I did pick a primary care physican who trained with my WLS surgeon, so he at least knows a little about my insides and needs! But on a good note for me, the plastic surgeon I have consulted said she gets a lot more approvals for the tummy tucks and such with my new insurance than my previous! If I were you I would just call around to a few plastic surgeons and ask to talk to soemone in billing that works with insurance and see what they say! That is how I learned everthing I know about my new insurance! Good luck Jesi

my bc/bs did pay for a breast reduction which is a plastic surgery of sorts, but it seems that they're dropping wls coverage at the beginning of this new year because of all of the medical expenses that follow the surgery. if you had wls before 2005 then plastic surgeries to remove skin should still be covered by bc/bs. the likelihood is that your arm surgery may not be covered but your stomach may be. i will totally knock wood for you!

I have WBCBS of Ia ins and they are still paying for WLS. I called last week to be sure because I have my initial consultation this Fri. (1/7/05). I have Alliance Select but I dont think it would matter which plan one has. Maybe you were misinformed I would double check. Good luck

Hi Patty, It all depends on whether or not the employer opted to select the coverage for WLS, etc. Sherry Open RNY 02/04/04 (Proximal-75 cm) 294.5/154/150 -140.5#

Tracie, Could you give me more info on the HIPPA thing? My employer changed ins. companies when i was 10 months out from surgery...and the new one says they will cover NOTHING WLS related. I had to pay $900 of post op yearly bloodtests out of my own pocket!!!!! (well..i haven't paid YET..but still). Any help you could give me would be GREATLY appreciated! Thanks! ~~Dawn Phillips

We have/had Aetna through my husbands work. They paid for my wls and my arms. As long as you're willing to submit documents regarding why you need your surgery and submit pictures they are good about coverage. When I went to have my arms done my plastic surgeons office manager flat out said "I've been doing this for 25 years and insurance comapanies NEVER cover arms. They are considered cosmetic." Welp guess she has to change her tune. Dr sent in a very simple letter and pictures of my arms and 1 month later I went under the knife and had to pay a total of $200.00 out of pocket. Keep in mind I had VERY bad arms and had 8 inches of hanging skin taken off each arm. We now have BC/BS as of 1/1/05 and submitted this week for my tummy tuck. Good Luck!