Need advice about insurance.

Hello All, I'm new to Obesity Help, and I'm so glad to find a local Michigan group here! I've been jumping through hoops, trying to get approved for RNY surgery, but I've found out that my insurance company has excluded weight loss surgery!  So, I'm trying to decide what my next steps should be.   Currently I have saved up enough money to pay for Bariatric Surgery out of pocket, however I'm afraid to go that route since my current insurance company through my work has stated that they will not cover complications from the surgery. My husband is self employed, so I could potentially buy secondary insurance through his business, but how can you find out if an insurance plan covers bariatric surgery?  I've called a few insurance companies, but they have not been very eager to talk with me about this.  Actually, they've been pretty tight lipped and rude.   Anyone have experience with buying independent insurance out of pocket?  Any recommendations on an insurance carrier that I could go with for this? Would I have to get rid of my Primary insurance, if I get buy secondary insurance to cover this? Does anyone know any professionals (lawyer or insurance experts) that I could hire to help me look at insurance options, and help me navigate through this mess? Thanks so much, and it's nice meeting you all!!! -Sandra

My first question is, do you have any other insurance plans through your employer available to you?  If you do, I would inquire as to whether or not they cover WLS and you could switch during your companies open enrollment period.  Next, if your husband has insurance available but is not signed up, find out if his employers plan would cover the surgery.  Again, you would likely have to wait until open enrollment.  As for individual plans you purchase on your own, I have heard, but do not know if this is across the board, that they usually do not offer this benefit to individuals.  It may not hurt to contact an insurance sales rep and see if there is a plan available that would cover the surgery.  Otherwise, if you can pay for it, and that is your only means, why wouldn't you?  I know it is expensive, but it is an investment in  your health and your future.  When I was denied 3 years ago and then again 2 years ago, if I had the money to pay out of pocket I absolutely would have.  I am fortunate now to have a policy that covers it minus deductible and copay (about $2000 out of my pocket, but will be so worth it). 

Your first step needs to be to make an appointment with the Human Resources department at your work.  They should have a benefits coordinator... or  maybe talking to the director is the best option.   Many companies do not even realize that they negotiated away the employees' ability to have WLS.  They go into meetings with the insurance companies and try to get the best deal possible on premiums and the only way to do that is to eliminate entire sections of the coverage options.  "Sure, let's remove option 13 from the list of coverages so we can save $5 per employee."  But they don't know what "Option 13" included exactly.   So talk to your benefits coordinator, let her know that the insurance coverage you have excludes WLS.  And go in armed with INFORMATION about why WLS is a positive option for employers.  Less overall healthcare costs once your co-morbidities are gone, less cost for perscription drugs when you're off all your medication, lower absenteeism, higher employee morale, healther employees, etc.  Don't go in with a sob story or an emotional plea, you need cold hard facts at this point.   As if they can add WLS coverage to the next plan year or if they would be willing to negotiate with the insurance company to include the coverage now, mid-year.  Or maybe they can buy a special rider for the plan to cover WLS now and add it later.   As for lawyers... if the meeting with your HR department doesn't work, then you might consider checking out www.obesitylaw.com --- and also visit the Insurance Forum here on OH.  (One of the lawyers from Obesity Law moderates that forum and is there to help answer questions.) Good luck Pam

Pam's right....although I don't have a WLS point to add, I wanted to let you know that sometimes people don't read the fine print or pay attention.  Our insurance agent called me the other day and told me that there was an available rider for our company that would cover 1 yearly mammogram and it would only cost an additional .65 a month per member.  She wondered why we didn't choose that.  Well, the company is owned by a single guy, and the previous Controller was a single older man who didn't care about the insurance needs of everyone.  You can bet your boots I had them add that rider!  While I was at it I also added the birth control coverage for less than $10 per year per member.   So it does pay to ask and see if things can be changed.  You might have to wait until the renewal, but it would be worth it!