Ohio WLS questions

Hi -- I'm a newbie here, but think someone might be able to give me some info. My husband & I live near Seattle now, but will be moving to the Columbus area next spring. Our current HMO is in the Northwest only. My husband will retire in January, & we need to decide if we want to stay with our current HMO until we move, or switch when he retires, to a company that's also in Ohio.  I'd appreciate knowing the names of some insurance companies that cover wls. Then I could check them out further & see if they're on the Federal Retirees list. My MBI is 42, but our bariatric surgeon here isn't keen on doing the surgery when I'd be moving from the area a few months post-surgery. I see the wisdom in this, even though I'd love for him to do the procedure.  Need to learn if I do the 6-month supervised weight-loss program out here, will it transfer to Ohio? After I lost the prerequisite 10 pounds or whatever, & my BMI goes down, will I still qualify for wls? Lotsa questions! pauline seattle, wa.

Pauline, these are loaded questions.  By that I mean, there are a hundred different answers to each!  From what I understand about insurance companies, it is not so much whether they will cover it or not, it is whether you are buying the insurance package that covers the procedure.  For instance, I had UHC.  Some got it covered  but my plan wouldn't.  It was because the plan my company purchased did not include this level of coverage. Sorry, I don't have any advice on insruance other than wishing you luck in the process. As for the questions re pre-weight loss and bmi, you will need to talk to the surgery team that you select to see what they say.  Your best bet may be to begin by researching a great doctor in Columbus.  Then call them and get them working for you.  They will do the leg work on much of this because they want your business.  When looking for a doctor look for someone who does both Lap and RNY - if you haven't selected a procedure yet.  Then find out how many ops they have done.  In my opinion you want someone who has done more than 500 of each.  You want someone who is experienced and who has seen it all so they know what to do in the event of an ER.  The other thing is see if they have a best practice accredidation.  Good Luck!

Steve

Steve, I like your idea about checking for Columbus docs. My daughter lives there, & she can do some of the legwork for me -- helps make up for all those midnight feedings & boyfriend crises!

pauline

seattle

Every policy is different even if it's with the same insurance company.  I had Medical Mutual of Ohio when I had my Open RNY in 2003 and EVERYTHING was covered and they were very easy to work with.  While MANY OTHERES that had MMO only cover up to $10,000 and they were VERY HARD to work with.  It all depends on each company and what they want to put in the policy.  AND even then things can change again at the first of the year.  To me it sounds like you need to call the Federal Retirees people and ask them what of their carriers are in OHIO then call all of them to see what EACH POLICE STATES about covering WLS.  Ask  them what medical records would transfer what wouldn't.  I have read from several that even when they change doctors they have to start the porcess ALL OVER AGAIN even with the same insurance company. WHILE otheres EVERYTHING has transfered without a hitch. As far as your BMI going down I would think that if it goes under 40 then you would NOT be able to get covered. MOST insurance companies want a BMI of 40 or higher some will take 35 if you have co mobities.  If you really want this I would check out OTHER DOCTORS in your SEATTLE area and go head and get it done before you move. People move all the time some with little or no advanced warning and have to take their medical records with them and find new doctors.  On a side note many years ago my husband and I had to move form Washington DC to Ohio with only 2 weeks notice and we were living in an apartment. Thank goodness we were just on a month to month  and there was a waiting list to get into that apartment community.   Good Luck in whatever you choose.  Robin

Robin, I can see that there's a lot of info-gathering I need to do before we move! One of the advantages of waiting for the surgery until we move to Ohio is that we'll have sold our house out here in a robust market & will be buying a home back there for a much lower price. (Our daughter's home that they paid $210,000 for 2 years ago would go for at least $500,000 here.) So if things work out like that for us, we'd be able to have the surgery without insurance if we needed to.  Sheesh! I feel tired just thinking about all the pre-pre-op stuff that needs to be done -- on top of getting our house ready for sale. The folks at Home Depot & Lowe's know me by first name! pauline seattle

Pauline, I am a retired Federal employee.  I sent you a message to your personal message board.  Bottom line, it all depends on which Federal insurance you choose to go with.  Open season is in November so that is a good time to check them out. I personally have had BCBS FEP (Standard Option) for years and keep it in my retirement.  It is great insurance and paid all my RNY, except for co-pays.  I didn't even have to do a 6-month diet.  I went back to work (for an airline) after I retired and decided to keep my Federal insurance instead of taking the airline's group plan.  It is that good. Please feel free to email me if you have any questions. Kathy

 

 

Kathy, thanks for your info about BCBS. I went to their site but couldn't find out anything about wls except that they do cover it. On tuesday I'll made some calls to the local office, & try to light a fire under my husband to pick up some literature at work!

Like Kathy, I'm covered by BCBC FEP in Ohio.  They were wonderful to work with, had me approved in 8 days after they received the paperwork.  I ended up paying the surgeon $150, the hospital $100 and some odds and ends of co-pays for all the doctors I saw to make sure I would live through the surgery (including a vascular doc and pulmonary doctor).  Co pay for the psych eval was $50.  Biggest expense was the ultra sounds on my heart because I had taken redux and phen/fen in the '90s and I was still meeting my deductible. Gabby

I have Aetna HMO and was able to pay $250 for the surgery and everything else was covered. As long as you have docomunted info from a doctor about the 6 months of diet, etc it is usually enough for them. I'm in the Columbus area as well and I went to the Barix clinic. You can always call them and check to see if there are other things that you might need. If I can be of any help let me know.