Post Op..Can't get reasonable Insurance Coverage

I am nearly 5 years post op, and after going through a divorce, lost my health insurance. After trying to reapply for a individual policy, I was denied due to my gastric bypass..even though I have never had the first complication... ..and when I finally did find someone to cover me, my premium was going to be $700 a month...I ended up having to take out a policy that excludes any thing relating to my wls..and is pretty bare bones and doesn't provide much coverage at all....I have been unable to return to my Dr. for my check ups and am finding it harder and harder to keep my weight off. Anyone have any advice or suggestions?? It seems unbelievable that Anthem..the very company who covered my WLS now denies me insurance because of it.

Hi svcboone, I'm so sorry to hear you are having insurance problems.  I understand how important it is to have good after care and I hope you can see your surgeon soon.   Now, please know that I am not an insurance expert, by any means, but I did buy insurance via COBRA and then HIPAA so that I could avoid problems with preexisting conditions. Utilizing Cobra and HIPPA may not be an option for you but just in case, I figure it can’t hurt to look into it.  A couple of questions come to mind…  1.  Was your previous heath insurance (thru your ex-husband) an employer sponsored "group" policy?  2. When you lost that coverage, as a result of your divorce, were you offered the opportunity to purchase the insurance under Cobra?   3. If it was offered, did you get Cobra?

The reason I ask is that it is my understanding that typically as long as a person has "group" insurance coverage and continues with Cobra without a lapse in insurance coverage, one can typically qualify under HIPAA to purchase insurance without preexisting conditions being a problem (when the Cobra runs out).
I hope that makes sense.

The health insurance protection is part of HIPAA just not the privacy stuff that we are typically familiar with lately. I found some helpful information at the following link and pasted just a little bit of it below: http://www.dol.gov/dol/topic/health-plans/portability.htm The Health Insurance Portability and Accountability Act (HIPAA) provides rights and protections for participants and beneficiaries in group health plans. HIPAA includes protections for coverage under group health plans that limit exclusions for preexisting conditions; prohibit discrimination against employees and dependents based on their health status; and allow a special opportunity to enroll in a new plan to individuals in certain cir****tances. HIPAA may also give you a right to purchase individual coverage if you have no group health plan coverage available, and have exhausted COBRA or other continuation coverage. I hope this helps.... feel free to e-mail me at [email protected] Best of luck,  Amy

 

Yes, my ex-husbands insurance was through his place of emplyment, and I was give the opportunity to pick up COBRA, however, I couldn't afford the monthly premium..which was close to $550 a month for just me...I have since been able to obtain insurance through a company called United American, however, it has an exclusion for complications relating to my gastric bypass. The most unbelievable thing of all of this is I have no medical problems at all, on no meds and am healthy than I have ever been and now I can't get coverage??? Word of advice to anyone that is having this surgery or considering, dont ever loose your insurance!

Thanks for your post!!!

If the time between insurance policies, that is the time you were uninsured, is less than 30 days, then the new group policy cannot deny treatment as a "pre-existing condition".  If you were uninsured for more than 30 days, the new group policy can include a clause that excludes any treatment for a pre-existing condition for a set period of time, usually a year.  I could be wrong, but I don't think the HIPAA regs include any specific rules for individual policies....as in I think they can set up the contract to read any way they want to. If you explained the situation to your MD, could he diagnose something other than WLS? If he sent in your labs with a diagnosis of "anemia" or "abnormal loss of weight", or even used diagnosis code V726 (routine lab exam) the insurance co might screw up and pay it.  He could easily bill an office visit with a diagnosis other than WLS and they would pay it.  Check with the insurance company and find out what your benefit is for "preventative medicine".  If they'll cover routine check ups, then the  doc should be able to bill an office visit as a "routine physical" and the insurance should pay.  Or, pay cash to the WLS doc for an office visit, get his recommendations for you for the next 6 months or so, and then take those orders to your regular MD.  Let him order labs and bill it as a "routine physical" or whatever.  Talk to the doc and/or his billing office.  You have nothing to loose, the worst they can tell you is "no".