Insurance

So I tried to change my insurance so it will cover or help cover weight loss surgery. I was told that as of 2015 they are no longer covering that procedure and just about all other companies are not going to cover it either. Does anyone know how true this is and if there are other options I could look at? The surgeon I went to see several months ago said paying out of pocket isn't the best choice just in case there are complications. But I don't know what else to do. Are there other ways to get help? I'm at the end of my rope. I am 30 years old with a 2 year old to chase after and all this weight is keeping me from doing so. Help

It is absolutely NOT true that "about all other companies" are not going to cover WLS anymore.  In fact, more companies are looking at it as an effective means to cut down on their cost of covering co-morbidities like diabetes.  BCBS in most states is still covering it,  my husband's Aetna plan covers it but has a dollar limit on how much they'll pay. 

Of course you still have to jump through a lot of hoops to get it approved.  If you can afford to, I would research other plans.  But I understand if your employer's plan is excluding it that will make it difficult for you.  

Actually, a number of companies (but certainly not most) are now dropping it in order to control costs and because they're finding that within the first five years they actually aren't seeing any health savings (and most people don't stay on one health plan for more than five years, the point at which the bean counters are saying the dollar savings actually kicks in).

I have seen several articles in material at the clinic I do psych evals for part-time, and a couple of people who started the WLS process last year have now discovered that their coverage was discontinued as of Jan 1, and are having to fight to get the surgery covered now that have completed, or are about to complete, the pre-op requirements. The woman I met with last week who just discovered it works for a fairly large company that has a good health care plan.

Lora

Was it one of the WLS that they will no longer cover or all WLS? 

As for companies not covering WLS that is a lie.  Some do and some don't it really depends on the company.

Thank you for your help, I don't have insurance through an employer. I have individual coverage. Do you know of other companies I could try? I have Anthem at the moment. I desperate

Kaiser HMO covers it through my employer, although plans can vary. I still opted to self pay in Mexico, it was a wonderful experience just got home today :) I'm right on the borderline of a qualifying BMI, and I didn't want to take the chance of jumping through all the ins co's hoops and still getting denied. Got excellent care as a self pay. Wrote about my experience and pix of the hospital HERE :)

I am the Admin for Insurance at work.  I called our agent and asked about weightloss surgery and she said no we had no coverage.  So I said can we change coverage?  she said due to our small co. size of 7 we wouldnt qualify to have a plan that would include WLS.  She said at one time many plans included coverage it was common even.  Then she said it got to be popular and what the insurnance co thought were thinner people started to find reasons to get the surgery.  They started to exclude it in their plans.  I think its all BS that people like me who need it can't even get it!  I am going to have VGS surgery March 9 as a self pay patient it is my only option.  I am scared of the what if's if there would be a complication.  I pray pray pray there are none.  Best of luck.

It's not necessarily that insurance companies exclude it from their plans, it's that employers can't afford to pay their share of cost for plans that cover that procedure.  As you would guess, those plans are more expensive. 

What your employee insurance plan covers is primarily dictated by your employer, not the insurance company.  That's why someone's BCBS plan in Iowa may look totally different than someone's BCBS plan in Illinois...or even in the same town or state!  Employers can choose from a menu of services.  Fewer services = lower costs. 

If the employer and employees want higher health care costs they can certainly choose a more comprehensive plan - they're out there.  But typically nobody wants higher premiums.  

If you are a self insured/ individual insured then some plans may exclude the bariatric coverage. 

One thing to check is see if the state you live in includes bariatrics on the state Essential Benefits list. You can check this by calling your state department of insurance. I think only 11 states include it on the list. I know WA state does not. 

Next, if you do live in a state where bariatrics is an essential benefit and are self insured/individual insured then there will still be BIG hoops to jump through depending on your specific policy. For example Blue Cross Blue Shield policies are different depending on age and your primary residence zip code. Sounds fishy right? Well it ****** me off too. 

My husbands employer insurance used to cover it. However now that Hasbro changed our policy jan 1 2015 his employer now pays for all health claims in out of the company dollar and only has medical insurance to handle the claims like a third party contractor for paperwork. therefore since the employer is self pay they legally can completely exclude alll coverage. but instead they have now increased the requirements. They now require 5 year history of bMI over 40. 

Most plans will say surgery is covered if BMI is over 40, with documented 5 years at bmi over 40 plus an actual diagnosis of morbid obesity for over 5 years. Also a 6 month medically supervised weightloss diet, and an additional 6 month wait period after approval. 

Or BMI of 35 plus comorbidity. Usually only type 2 diab, hypertension, and SEVERE sleep apnea. PCOS does not count. 

Note if you have to do a 6 month supervision do not miss a monthly appointment. You'll be denied. 

SOME companies/plans are eliminating coverage for "extras" like WLS in order to keep costs down, but definitely not ALL of them. It is significantly harder, though, to find an individual plan that covers it -- or to find an individual plan that you can afford that covers it -- because that coverage increases the premiums significantly. It is much more common to find it covered by an employer's group plan.

If you are having trouble finding an individual plan that covers it, perhaps you could contact whomever covers the "Obamacare" website for your state and let them know that you are specifically looking for WLS coverage.  They may or may not know enough about the individual plans to be able to tell you which ones cover it and which ones don't, but it is worth a shot. Understand, though, that one that covers it is going to cost a lot more per month.

Good luck to you.  I hope you find one.

Lora