please help me

This will be my second time trying for WLS. My husbands ins plan doesnt cover it at all, in any way. My ? is this. First, I am stupid when it come to ins. I am wondering if I can take out a plan for myself, like through Anthem, maybe, and then have this surgery. I looked up different ins. that cover WLS surgery and this was one listed. I would pay monthly premiums right? and then the deductable right? oh please help me so I know what to do. Many thanks! Nikki

Nikki, I wished I could give you something to go on but I really don't know about paying for a plain and then get the surgery. But I didn't want you to think no one answered you post. I hope you luck in get and ansear. Lisa

Nikki you are not stupid...first let me say search and look at the fine print when it comes to health insurance. Yes make sure they cover obesity and surgery and also make sure their isn't clause about pre-existing conditions (those medical problems you have prior to application of insurance.) Most of the folks who have had surgery will tell you that each company have their own rules about bariatric surgery and most them include lots of documentation about co-morbidities (those are conditions like high blood pressure, shortness of breath, diabetes, back problems, high cholesterol, etc that are a product of obesity..this is just a list...also many insurance companies have requirements like dietary instruction for a certain time to see if you can loose with modification of eating...some range from 6 months to 18 months...so look around see what the requirements and cost is...good luck...I am waiting for a answer myself and am sure I will have do some dietary instruction to satisify the pre-certification....linda

If you have already started the process of investigating the surgery you may be out of luck with getting coverage unless there is a serious health issue related to you being overweight. You may be better off setting up a payment plan (which may be the same all around cost as deductables, monthly ins payments, etc anyway) to pay for the procedure. My ins didn't cover the sx, so I set up a payment plan with the center, and all went fine.

Hi Nikki, why dont ya try askiing the Insurance help forum? There might be someone on there sho has done the same thing, or knows someone who has. Good luck to ya! blessings! betsy

Nikki I would call anthem and ask them how long u have to have the insurance before they would cover a surgery like that. Ask what they require for this surgery. Explain that u have insurance now but would like to change if they cover it...u dont have to give them your name or anything to find out this kind of info. Then u can find out if its worth the premiums or not.

Nikki, I think most insurance companies doesn't normally cover WLS for self-insured. As has been suggested, ask, but ask specifically for self-issured. I know with Anthem, it all depends on which company it is through as to which benefits it covers. Anthem is one of Lilly's insurance choices for it's emplyees. Lilly funds the majority of the policy expenses, the employee pays a very small portion of the premiums. If Lilly says 'we think 20% co-pay on scripts is good', Anthem will include that in their policy and build that into the premium. If on the other hand Lilly says 'The most I want anyone to pay for a name brand drug is $30', then the policy (and charges) are adjusted for that. If Anthem was also the insurance choice for GM and GM said 'I want our employees to only pay $10 co-pay for a doctor's visit', that is how their policy (and premiums) will be designed. So yes, you may see where Anthem covers WLS...but...it may be dependant on who the employer is...because that is who Anthem considers the insurance policies are through. I have Anthem through Lilly's. I can't call them up and say 'I want vision expenses added to my policy' because the policy isn't through me, it's through Lilly's. Lilly is their customer, I'm just included in the policy, that's all. With self-insured people, they don't have anyone going to battle for them so they are pretty much stuck with what the insurance companies offer. Think of it like your car insurance policy. Let's assume your husband set it up with Allstate. He and Allstate would have decided about deductions, toll package, amount of coverage for liability, etc. Your husband would have included every driver in your household and every vehicle. Let's say you had a 18 ys old son included as an insured driver. He wouldn't be able to call Allstate and make any changes to the policy because it was your husband who Allstate has a contract with, not your son. I know this isn't an upbeat, everything will be alright post, but I wanted to give you a heads up on the battle you may face. Is there any chance of your husband being able to switch insurance companies? Does he have a choice? We do, but can't exercise the choice until November of each year (to take in effect the following January). As was suggested, you may want to check into getting on a payment plan with a surgeon instead. It may be cheaper that way anyway because the full price of a self-insured premiums are ~$300 and up a month. Besides, if you spent the money on the surgery instead of on insurance, anything over 6% of your households gross income for the year is tax deductible for your income taxes. How's that for finishing on an upbeat note? Best of wishes! Sherri