I feel awful for my niece

My niece called me today with horrible news. The company she works for is changing their insurance over to CIGNA and they do not cover weight loss surgery. She had an appointment with Dr. Boe coming up on Jan. 29th for a consultation and now her new insurance starts on Feb. 2nd........too late!! She has been coming to Sat. and Wed. meetings and talking to Robin (lapband leader). She was finally ready to do this and now she has been straight out kicked in the face. She cried all day today. I feel so bad for her. Sometimes life just seems so unfair. I told her to call Barix and they told her that the procedure costs $25,500 and there is no way she could afford this! Barix canceled her appointment for the consultation. ugh!!! Now what???? Does anyone have any advice? Can insurance companies just not cover any weight loss surgeries??  Is there any way at all to make your insurance cover it or any other options that you know of?????

Thanks......Kathy

Unfortunately they don't have to cover it - she can of course appeal. depending on her BMI, Co-morbities, age etc she could win an appeal.

I am so sorry she has to go through this!

Liz

Kathy, sorry your niece has to go through this.  I work for an insurance company and unfortunately, if the company did not choose to cover it, there is nothing you can do.  The only possibility is if there is some kind of clause stating that if the service is done within a certain amount of time of the termination of the prior coverage that it could be covered.  But, even with that clause, since she did not start the process yet, it probably won't matter.  It is a common misconception that it is the insurance company that decides what will and will not be covered.  This is not always the case.  The person's employer actually chooses what will and will not be covered and the insurance company just administers the benefits.    The only other possibility would be to appeal to the employer to see if they would include coverage for it.  Many companies don't realize that the benefits of having the surgery far outweigh the medical expenses they will have to cover for people who don't get the surgery and have or end up with the many comorbities that come with obesity.

Good luck to your niece.  I hope she finds a way to get it covered.

When I started all of this I found out that my current employer (state university) did not cover it because I was in "too high" of a union level.  I was so devastated!  The HR person literally told me that if I was on the grounds or cleaning crew, it would be covered.  But mid-management was a no-go.  There are 6 different union levels at the state schools, and they all have the same insurance provider, but different options in each plan.  It's ridiculous!

There were other things about my job that weren't working and overall I didn't feel it was a healthy environment for me to achieve any success in, with or without wls.  6 months later in June, I switched jobs to work at another college.  It was approved without hesitation day 1.  Funny thing is, my insurance at my new job is 10 times better, considerably cheaper and the work environment is healthy and supportive - just what I need to be successful on this journey.

I had no idea when I switched jobs if it would be covered or not.  I just knew that it would be a healthier place to work overall - and the rest fell into place.  It was another moment in my life that I can look back and say "everything truly happens for a reason".  Has your niece considered looking for a job with another company?  Just an idea - as I know the appeals process with insurance is basically impossible.

My heart goes out to her!

I'm really sorry to hear about this - and feel terrible for your niece. Dr Boe did my surgery and I absolutely love him but I know paying out of pocket for most people just isn't a consideration. Its really a shame that her new insurance doesn't cover WLS but tell her not to give up - write, call, talk to people about it. I had to jump thru hoops 2 years ago to get my insurance to cover it, and now it's covered without any stipulations other than you have to go to a Center of Excellence for the surgery. So insurances do change - please tell your niece not to give up.

Kathy

Hugs to you and your niece.  Out of pocket also would have been a no go for me.

Lisa is right in the fact that the insurance company doesn't always choose what they pay for.  Things like this are written into policies based on the employer.

Not sure if she could look into getting her own private insurance or if she has a husband that she could pick up his benefits for - although open enrollment is closed at this point in time.

Hugs to both of you - my heart goes out to all of you and everyone affected by these problems.  Definately tell her to keep an eye on her policy and what not and see if anything changes at some point.

Thanks everyone for all your suggestions. I'll let my niece know whay you all have said. I love how kind and caring you all are......thank you so much!!

Kathy

Have her call back and see if they can call her if some other patient has a surgery canceled before 1/29.  It happens, and she may luck out and be able to squeeze in before she loses her old coverage.

I hope everything works out for her.