Any expeirence with private self insured plans?

Good morning, I am wanting RNY but my insurance company, Aultcare, in OH, has an exclusion policy. Why couldn' t I go out and buy a policy thru Cigna, UHC, BC/BS or any other company and then submit my request? Has anyone ever done this? IF so, which insurance co. would you go with????. Thank you so much for your input...

Lynn: There can be significant differences between group insurance (offered through an employer or the employer of one's spouse) and an individual policy. The first thing that comes to mind is pre-existing conditions, which almost all individual policies are going to subject you to. A pre-existing condition is a condition that any "reasonable" person would know that he or she had but refused to get treatment for until he or she was covered under a health plan. Insurance companies apply pre-existing conditions on most individual policies because the cost to treat a new member of an insurance plan will be invariably more expensive than what the member has contributed to the plan. In essence, it is a cost-mitigating tactic by the health insurance company. In essence, you are free to go out and purchase your own coverage. Please be aware, however, that insurance companies will scrutinize your health so as to ensure that you do not pose a substantial risk in covering. Most people benefit more by being covered through their employers because health insurance companies do not typically apply the same standards of coverage as they would to an individual. In my estimation, you would do better by fighting the exclusion on your current policy through submitting appeals demonstrating the medical necessity of your particular situation. If you have access to legal counsel, you could also work with that party to ensure that your rights are being met in regards to having the insurance company pay for the surgery. I would, however, suggest against seeking individual coverage. I hope I was able to assist you.

You know you're probably right...I talked with one rep and the out of pocket expense was going to be as much as if I'd been self pay....so ...I don't think I'll be successful with my ins. co.either. I am just under 40 BMI and I don't have any co-morbities...so self pay will probably be my only avenue.Thank you for your time and input...much appreciated.