Is Individual Insurance and Option?

During the last week in June, when I was almost done with my 6 month diet we received a notice that my husband's company was changing insurance companies from Highmark BCBS (which covered WLS) to CIGNA which does not (unless the plan is a self-insured plan).  I had all of my letters, evaluations and tests done and submitted to my surgeon and we had the rug pulled right out from under us. Since then I have been living in shock and denial.  I am finally realizing that I was to be having surgery this month and working toward my new life so I have to figure something out.  We cannot afford to pay for the surgery.  We are having financial difficulties because I am unable to work. My husband is healthy so we thought about getting insurance on our own.  I have never had individual coverage.  I don't even know where to start.  Is this even an option or will my health problems prevent us from getting individual insurance? If there is a chance we could get individual coverage do any of you have any recommendations as to who to go with?  We live in Missouri (St. Louis).  Will I need to wait before getting the surgery?  Anything else I should know about individual coverage? Any advice is very much appreciated!

My experience - 1) They will automatically deny coverage for anyone with a high BMI and 2) They all exclude WLS period, anyway. I've looked high and low, and individual coverage will not cover it. I was told by one guy on the phone that it would be insane for them to offer it because people would buy the plan, have the surgery, then drop the plan costing the insurers thousands, if not millions. Insurance companies aren't in the game of promoting health, they are in the game to make a profit.

I want to comment on two topics. First, being in the game to make a profit is the reason that businesses operate in the first place in our capitalistic society, so I don't think it reasonable to assume that it should be different for health-insurance companies. While what the person told you over the telephone was callous and unprofessional, it makes sense based on how insurance companies operate, which is on the basis of a risk pool.  If everyone hops in the pool just to take thousands of dollars out without contributing something even remotely close to that amount, insurance companies would be bankrupt trying to cover everyone's procedures.  So, short of instituting socialized medicine, that's what we have to work with. Second, as for individual policies' not covering you, I would say to do your own research and talk with different companies.  Just as the previous poster mentioned, if you have an impressively high BMI (basically, something in the overweight range), you are going to have increased difficulties finding companies that will cover you, let alone that will permit you to go for an expensive procedure such as bariatric surgery.

Did they give you a date that the coverage would be effective? I know from experience that it usually takes a couple of months for the change to take effect; thus giving you a small window!!!!

The effective date was July 1st.  We were notified less than two weeks prior to the effective date.  My husband's company has more than 900 employees and it was a mad dash to get us to fill out and return the paperwork by the 30th.  It was definitely crammed down our throats.  I didn't even have time to schedule a surgery and I didn't have the precert yet because I still had about 2 months left on my precert diet. It was a really bad time.

Sweetie, I am so sorry that they played nasty with you.  I have a friend of mine who works 3/4 time at KMart and is having this surgery. (no WLS exclusions) Can you work part-time somewhere that has good insurance?  I have also heard that Home Depot has great benefits.

Thanks for the suggestion.  I thought of that, but I stopped working about 3 years ago.  My anxiety, depression and agoraphobia made me very unreliable and unable to deal with the simplest things.  I have 3 degrees and I can't even leave the house without heavy medication to keep the panic attacks and diarrhea to a minimum.  I have applied for disability (after 3 years of an internal fight for ethical reasons).  We have even thought about getting a divorce so I could get on Medicaid, but Missouri has cut back medicaid and the disability funds would keep me from qualifying -- anyway, I am pretty sure it would be illegal. We thought about my husband changing jobs, but I cannot allow that.  He loves his job and it took a lifetime to get to where he is happy with his career -- and it puts the food on the table. I wish I would have given in and filed for disability years ago because my problems have caused us incredible financial hardship.  Our savings are gone.  We sold our home and now rent a smaller place to keep costs down.  I am so frustrated I could just cry ... or scream.

i am not sure what type of disability you have applied for. My ex-husband had numerous anxiety and panic issues, along with being bipolar and having had a closed head injury. He was on SSI and received Medicaid. I am glad to hear that your husband has a job he loves.. that is a huge battle for most of us! I hope that something will pan out for you and that you can continue the journey that you so desperately want. I will keep you in my thoughts! {{{{{{{{{{{{{{{{HUGS}}}}}}}}}}}}}}}}}}

Thanks again for the info and mostly for your support!  It really does help me to get through the day to hear from people who are truly concerned and want to help me to find a solution. I am applying for Social Security Disability.  I earned a good income for many years so I should be eligible for enough to prevent me from getting SSI.  Missouri's Medicaid program is slated for elimination next year.  I can't imagine that our General Assembly will allow that to happen, but our Medicaid is already reduced to providing support for children in the poorest of the poor families and our poorest elderly.  Some adults qualify, but very few. People *****ceive SSD are eligible for Medicare, but only after 24 months.  I can't understand that.  That policy is ridiculous.  If someone becomes a quadrapalegic they must wait 2 years before they have any access to health insurance!  I do not want to be on disability, I don't want to be useless.  I want to have a life and become productive again.  I would think the Fed would prefer that where possible I am given the tools to get off of disability so that I might contribute to the system rather than add to the drain on it. Arrgh!

Is there vocational rehabilitation in your state? here in NC if a medical issue such as this is keeping you from working (sounds like its related) they will help you. I hear its kind of a heavy red-tape process but they pay 100%