Being denied coverage years after WLS???

I am just about 3 years post op and my employer switched insurance companies. New company denied me because I had WLS and says its an automatic denial. Anyone else heard of this or have had any problems with this?  I can't go without coverage and am wondering where I can turn to next?

I'm pretty sure that they can't deny you. If they can, then your employer, I believe, has to offer you another plan that is equitable. If not, that is discrimination (and I imagine you'd have a decent law suit). If your employer provides a plan for all employees, that means all employees (even if the employee pays 100% of the premium, it is still offered at a discount rate through your employer). It's like saying your not covered because your HIV+ or have kidney failure and will need a transplant. And the fact that your prev ins covered your surgery, how can you be penalized? They could insist on a "pre-existing clause"-- although I think that only applies if you've had a gap in insurance coverage. Are you sure they didn't mean that they have a WLS exclusion and that you would be denied just for any WLS related issues? Hopefully Paul, Vicki, or Gary will chime in about this, as I am not sure of the legalities of this. But it sure sounds a lot like discrimination to me!! Good luck, and keep us posted, Kahlua

Hi, Thanks for the response. What the deal is, is that he went to another organization called NASE which is stands for National Assoc for the Self Employed or something like that and through them went with a "self employed" group coverage, so we are like on our own instead of as a group within a company like we were. And I was denied because I had had the surgery period. Not that it would be an exclusion or a preexisting 1 year clause or anything. And I asked them if that is a forever automatic denial or if after some time has passed they would consider covering me and they said they will not ever cover me because of the WLS I had 3 years ago. Which to me is so stupid since I am much healthier now of course and there have been absolutely no problems from surgery or anything. I just think that it is absurd and that their underwriters should rethink this policy. In the meantime I had to take on another fulltime job just so I could have health insurance, recently I wanted to cut back those hours or quit that job so I was looking into health insurance again and am finding out that no one will hardly take me because of the WLS, at least that is what this agent told me. I was just wondering if others have run into any problems like this.

Juleeanne I don't understand it.   If you had coverage under another carrier with your employer and they switched and there was no lapse in coverage there should be no discrimnation.  I could see them putting a pre- existing clause on you for 1 year which is normally done but even then if you didnt have any lapse there should have been creditable coverage from the previous carrier. I suggest you talk to your HR rep to see if they can shed any light on it.   Actually employers are not required to carry insurance its like an added bonus and if one individual is excluded I don't know the laws in your state and not sure there could be legal action or not, but I sure would be barking up your employers tree to see what the heck is going on.    I wish you much luck  Vicki

Hi, Thanks for the response. What the deal is, is that he went to another organization called NASE which is stands for National Assoc for the Self Employed or something like that and through them went with a "self employed" national group coverage, so we (the employees which consist of my boss his two sons and families and me and my family) are like on our own instead of as a group within a company like we were (we had in the past United Healthcare then Midlands Choice). And I was denied because I had had the surgery period. Not that it would be an exclusion or a preexisting 1 year clause or anything. And I asked them if that is a forever automatic denial or if after some time has passed they would consider covering me and they said they will not ever cover me because of the WLS I had 3 years ago. Which to me is so stupid since I am much healthier now of course and there have been absolutely no problems from surgery or anything. I just think that it is absurd and that their underwriters should rethink this policy. In the meantime I had to take on another fulltime job just so I could have health insurance, recently I wanted to cut back those hours or quit that job so I was looking into health insurance again and am finding out that no one will hardly take me because of the WLS, at least that is what this agent told me. I was just wondering if others have run into any problems like this.

You said the magic words Self Employed  or self funded.  Usually those type policy can pick and choose who they which to unwrite I know its ashame.  If you are looking for fulltime employment I suggest a large company, who gives their insurance to employees like right off the bat or after a probation period most of them dont have to unwrite you and get all kinds of medical history on you. Good Luck if anything else I can try to help you with let me know. Vicki

Yeah, I already have 2 full time jobs. I picked up one with benefits when I got denied, but I am looking to downsize and work only 1 job again or part time but am finding I can't due to insurance denial.  :(   I really hate this.