Which insurance?

I made a previous post regarding switching insurances now (open enrollment) and the verbage in one of our other choices which is BCBS of Arkansas. It specifically says that weight loss surgery/ gastric bypass is covered. However, they have a 300.00 deductible + 1000.00 yearly out of pocket max. (not much, I know considered to actual surgery cost) Well, today when I went in to do my new elections I suddenly realized that we have another choice. I was completely unaware that another choice besides the one we have now, that excludes WLS completely and the BCBS. The third choice is UHC EPO (United Health Care). I read through the summary (44 pages). I did not see anything stating that the surgery was covered. The only thing listed in the exclusion is this "Weight reduction or control unless there is a diagnosis of morbid obesity" I meet that criteria of being morbidly obese. UHC has no deductible &  no out of pocket max, only copays. Obviously the cheaper choice on our end, although the premiums are slightly higher, but my concern is would it be better to choose the BCBS because it very clearly states that WLS is covered and be safe? BTW, I did call UHC and the rep couldn't find anything stating that it was covered or a complete exclusion. He only found the part I found under exclusions... Which choice would you make? Thanks, Jenifer

Hi Jennifer, I'm sorry that I'm not much help to your question. But, I thought you might be able to answer one of mine. I currently have Cigna, and they cover the surgery as long as I meet certain requirements (i.e. certain BMI, etc.) and have the six months of documented physician directed weight loss. I just received my "open enrollement' packet from my employer and they are keeping Cigna. How do I find out if the WLS policies stay the same in 2007? I called Cigna and they told me that they could only talk about my current insurance (the 2006 plan.) Your message sounds like you have been able to read about your entire plan choices and options. My company only sent a brochure about the two Cigna plans and it does not mention WLS anywhere.

My two cents regarding your insurance choices would be to go with the plan that guarantees it and spells it out. But, my opinion is probably not worth much. I would just hate to finally make up my mind about the procedure (I think it's a huge decision that truly has to be made in one's heart) and then find out that the insurance company has some crazy wording that left it so ambiguous that they can say no. Again, just my little two cents. I'm sure there are many folks on these boards taht can offer much better advice.

Thanks for any info you can offer me. I'm going crazy worrying that my 2007 plan won't cover this. I started my physician related weight loss plan in August and am anxious to start my new life!

Miss C, My sis in law is in the same boat you are in. She can't find where to view the plans documents. When she called the ins company supposedly all they could do was to mail her the new 2007 booklet- after the 1st of the year. Not much help. I am lucky I guess. Hubby works for Alltel & they have all of their benefit info online including the extensive summary documents and links to the companies. I researched the summaries and called the companies. They were able to pull up the 2007 docs while I was on the phone with them, but couldn't see anymore than I could. I called HR and was told that it was covered as long as the BMI is whatever they say it needs to be. She thought 42 was what they required. I would certainly call your HR as someone else suggested. They should be able to tell you more. Good luck with it. Like I said, I did find out that UHC will cover it but I think it is going to be harder to get approved with them only because of how they word their benefit summary. I have decided to go with the BCBS (the higher standards is nicer too.)... Thanks everyone. Jenifer

Miss C~ I would contact your HR department that deals with benefits they should have the "paperwork" that will tell if it is covered and if not they can find out for you Thats what I had to do

I'm in the same spot now with open enrollment going on. Call and ask for a list of exclusions for the policy. I was given only a summary of benefits so I had to call and request the exclusions for both of the companies I have to choose from. Tom

I've always been partial to bc/bs... only b/c they have to meet certain criteria to keep bc/bs name... but that is just me.... talk to your human resources as before suggested. Don't just make sure they cover it, but find out what you have to do to qualify!