appt w/ Insurance Coordinator was pointless

kredfern
on 6/30/08 7:49 am

You will find that you need to jump through alot of hurdles to have this surgery and you will be a stonger person for it.  I would do your research now with the other insurance companies, that way you are prepared to pick during your open enrollment.  You could also find out what requirements each has for WLS.  If there is a supervised diet for a period of time, you could start that now, so you will be ready by the time you have your new insurance.  I know many people who have changed insurances for this reason, and have been successful in their WLS journey.  Good luck and keep us posted. 

Melanie B.
on 6/30/08 9:39 am - Doylestown, PA
Ashley, that just stinks that they made you come in only to make you pay and tell you it wasn't covered. i'd be pissed about that.

OK, so now for your insurance, and just so you direct your frustration at the right parties. Keystone Central and Keystone East (which I have) are the same companies. I'm just located in the Eastern part of PA and you are Central...they are owned by Blue Cross Blue Shield. My insurance covered WLS because my employer opted in for it to be covered. Having WLS included makes the plan more expensive ot indemnify and therefore makes it more expensive for your employer to have. So while your HR person is making it sound as if she doesn't know (and perhaps she doesn't realize it) It is actually yourcompanies choice to not have a plan that covers WLS.

I had this exact experience with United Health Care in my last job. There are plenty of people on OH who have had UHC cover their WLS so as you can see it depends on the type of coverage your employer chooses to have.

I tried for a year to 1. get my own insurance, however I was denied becasue of my weight (nice) 2. Approached my HR dept. to see if I could pay more weekly to have WLS included in my plan. all to no avail, I assure you.

Finally when I had just had enough (and was disgusted with my employer for being such cheap, heartless *******s - I quit my job and got my current job that does cover WLS.

So my reccomendation to you would be to as others have said, try and get your own personal insurance, and/or B - try to talk to your HR people about getting an exception made.

Also, ASK HR for a copy of your explanation of benefits. Is WLS a flat out exclusion (regardless of medical need)?

Best of luck dear, I know how totally fresutrating it is.

      

retta0426
on 6/30/08 2:23 pm - Middletown, PA
Or you could do what I did, quit the job I had that didn't cover the surgery and go work for a company that did cover it. I had a six month "pre-existing condition" clause, but hey, I waited those six months then had surgery and didn't have to pay for any of the surgery. Oh and as soon as the doctor released me to go back to work, I gave my notice and promptly.. quit. (retail work sucks, but it paid for my surgery!) I now work for the state and they don't cover the surgery either, but if there is a problem since I had the surgery, they will cover the expenses from that problem. Good luck!
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