Possible new insurance?! Will Obesity be a pre-existing condition?

I have insurance thru my husband work which is controlled by his union I am currently trying to get them to change an exclusion to gastric bypass. Today I found out that the insurance my employer offers covers gastric bypass. Here is the question does anyone know if I have already asked for and been denied by my husband's insurance if I switch to my insurance will WLS be considered a pre-existing condition? or Does that even matter when its an employer insurance coverage (by the way its, blue care select ppo). any info is greatly appreciated.

Shouldn't matter, I had my fair share of insurance problems also. I had to reschedule my surgery,and then my employer changed insurnace policies, not companies. (to save money, as usual). Our new policy was supposed to be equal to or better than, however now excluded bariatric/weight loss of any kind. I fought it two months! I finally won. Certain "pre-existing conditions" cant be declined for coverage by law. Not sure which specific ones, but imagine if you were pregnant, and the insurance you husband has changed. How could you be denied care? Or cancer? Are you sure with your husbands insurance though that bariatric is an exclusion outright, or is it only when medically necessary? If that's the case the doctor should have someone that works with the insurance company to get it covered. Its all how they present your case. I went to Dr. Noyan when he was in Freehold, and he was supposed to get me approved for a BMI under 40, but over 35. He never did, after countless calls to his office. Not saying it was him, but possibly the staff not giving him messages. Then, he decided not to take Horizon Blue cross anymore. I couldnt pay 26,000 at 30 percent. (out of network). I am going to his former partner, Dr. Washington, and he takes oodles of insurances. They also have a guy named Larry that handles the insurance company, and tells them what they need to hear. Its all in what the doctor says and some think they are too busy to help everyone.If your husbands insurance does not cover it, period, then investigate your potential insurance first. It may have limitations as to how much they might pay. I have horizon direct access and after dealing with them for so long on my issues, I've learned that they dont always pay all fees, depending on the plan, sometimes only RNY is covered, not lap-band. Best of luck! Lisa

I am little late in answering this question for you, as you may have already resulted to addressing the issue yourself. But, here is some information regardless. If you just found out that your employer's insurance offers coverage for gastric-bypass surgery, then you will want to look at all the puzzle pieces (let's face it; dealing with insurance can be puzzling at times.) The first thing that comes to mind is whether or not you are currently enrolled under your own group's (i.e. employer) insurance plan. If you are not, you will need to check with your company's human resources or benefits administrator to see if a qualifying event is required in order for you to sign up. A qualifying event is a predetermined set of guidelines that would allow you to sign up for health insurance at any other time than open enrollment. For example, a qualifying event would be the birth of a child. All states require that insurance companies open up their enrollment books to allow for the child to be placed on the policy to ensure coverage. Some other qualifying events include death, marriage or partnership, divorce or separation, or suddenly becoming ineligible from a spouses policy. If you are already covered under your company's policy and your husband's policy, then submitting to your husband's policy first typically will cause a denial, as you would be required to submit to your policy, per the rules of coordination of benefits. So, make sure that the denial reason under your husband's policy is that gastric bypass is not a covered benefit and not that you did not submit to the primary insurance company first (in this case, that would be your employer's insurance company). Regarding pre-existing clauses, that is something that is typically determined by the size of your employer or if the employer purchases a rider to omit pre-existing clauses. As a general rule, large groups (companies with over 100 employees) are not subject to pre-existing clauses. It is when working with a small business that you will most likely have to be concerned with them. Your explanation of coverage, summary of benefits, or benefits matrix will detail whether you would subject to pre-existing clauses though. You might want to take a good look at one of them, or contact the customer care department of your employer's insurance company to confirm that information. Of course, any correspondence to your health insurance company should be documented with as much information about the contact as possible. I hope this message provided some type of insight and assistance to your quandary. I will be praying for you. Respectfully, Xavier Derico-Smith