PLEASE HELP!!!!!

Let me start out by saying what a great tool this website is. I've found it to be extremly helpful and have gotten answers to lots of questions by reading different posts and so forth. Ok, now for my dilema... I work at a small animal hospital and we have HealthNet. HealthNet doesn't cover WLS which I found out after I went to an initial meeting held by the bariatric surgeon I was planning on seeing. I even had an initial consult with him, and his insurance specialist told me the bad news. This was about 1 year ago and I haven't been able to stop thinking about getting this surgery since then. I love my job and I feel torn. We've been having some problems with HealthNet and are thinking about switching to Blue Cross Blue Shield. I actually nagged my boss about switching and am sort of glad HealthNet has been screwing us over lately! It isn't set in stone though, so there is a possibility that they could decide not to switch or choose a different insurance company altogether. I was thinking about canceling my insurance coverage through work, and sigining up for a policy with BCBS on my own. I know it is going to be expensive, but has anyone had any expierence with this? I've looked online and most of the policies are POS and some ae HMO's. They don't mention anything along the lines of surgical care so I'm not sure about coverage. By the way, I am pretty clueless when it comes to insurance stuff :) I was also considering quitting my job (I've been here for 6 1/2 years) and getting a job with either the state or the city which has awesome insurance, but I would be totally miserable. I don't know which would be better. Also, the surgeon I am planning on using required visits with a cardiologist and a few other specialists in orer to get cleared for surgery. Would I be able to start getting these visits out of the way with my current insurance or should I wait until my new insurance goes into effect (that would be when my curent job switches or I quit and get different insuance, or I cancel my current insurance and pay for BCBS out of my own pocket). I know that a new job would mean that I would have to wait 3 months or so until I could be added to their insurance plan. My current employers are considering switching, but that wouldn't take effect until Jan '08. I don't know what to do. I am so unhappy with myself and I have wanted to have this surgery for so long and I feel like I need to do something to make it happen. A few of my friends don't understand why I would quit my job that I love and start working at a place where I would be unhappy just to get proper insurance to have WLS, but in my eyes, if that's what it takes, I'm willing to do it. Am I nuts?????? Anyone have any advice?

Hello Buttaflyz
I am doing m 6 month diet right now.If you purchase your own insurance it may have a pre-existing condition requirment. In other words they may say that you can not treat the obesity condition for certain amount of time. From what I've been seeing it's usually a year.Also even if you employer decides to change to BCBS it still may not cover wls. It all depends on the policy that you employer purchases.Some peolple can have BCBS and it may not cover wls in their policy. I understand what your going through. I need this surgery too.I know sometimes friends don't understand. I onl told one friend and she had wls already. Not everyone has struggled with weight. I am here if you need to talk. Oh also you may want to look into your employer adding a "rider" to the policy. That means they will add that service and you pay a higher amount for you coverage.I have sen a lot of peolple on here looking into that option. I don't know all the ins and outs about that. PErhaps some friends here can help too.

I am going to look into that whole rider deal. I'm pretty sure from what I've seen online, that HealthNet no longer covers any type of WLS. I think they stopped covering the surgery around ayear or so ago. I'm not 100% sure, but it never hurts to ask! I feel like I'm getting so close (as compared to where I have been in the past). It makes no sense that the insurance companies give people so much trouble when trying to go through this. It makes me so mad! Grrrrr

Are you sure healthnet doesn't cover it?   BCBS should but in your State many carriers have stopped. You will have a pre-existing rider if you have a gap in coverage longer then 45 days.

I am pretty sure, when I called them last year when I first started thinking about it, they told me no I wasn't covered. And after my initial consult with the surgeon, the woman who works in the office and handles all of the insurance stuff said that HealthNet doesn't cover it. I'm going to call them tomorrow and find out if it's a rider issue, or if they alltogether just don't cover it. If I had COBRA for insurance in the meantime while switching over, would that be ok?  What about if I started getting some of the pre-op visits out of the way (my surgeon requires patients to see a few specialists first). If I use my old insurance to cover these visits, will they still count if I switch over to a different insurance?

So I sent an e-mail to HealthNet late last night and I was surprised to see a response when I checked my mail during lunch. On this first e-mail they told me: Unfortunately, the following weight reduction services are not covered under your Health Net policy:  Bariatric, Gastric Bypass, Abdominoplasty, and excision of sagging skin. Care, treatment, procedures, services, or supplies which are primarily for dietary control, including, but not limited to, any exercise or weight reduction programs, whether or not recommended by Your Physician or Your Specialty Provider.  Complications resulting from morbid obesity or services provided for weight reduction, including Bariatric surgery and Abdominoplasty.  This exclusion includes specialized medical programs (including the excision of fatty tissue) or controlling obesity as a risk factor of other medical conditions. I wrote back asking if there was a different policy I could sign up under, or if there was a rider that I could add on to my policy and they responded: Thank you for contacting the Health Net Customer Contact Center. Unfortunately, this benefit is an exclusion to Connecticut Health Net policies.  Therefore, a Rider cannot be purchased to add this benefit. I hope this information is helpful to you.  If we can be of further assistance, please do not hesitate to contact us. LOL thanks so much! This information is extremly helpful! So you are basically saying that even though your doctor says you should have this surgery done, we won't cover it. Not only will we not cover this surgery, but we won't cover anything relatively related to this surgery. Thanks HealthNet!