new here and insurance excludes obesity related items
OK, I need to know if this is a battle that I can win...feeling like it might not be. I have United Healthcare (Choice Plus), the policy is through my employer, but my "employer" is a benefits administrator called Administaff. So I don't "know" the people there, they simply provide health insurance, payroll services, etc. to my true employer. To complicate things further, I don't know anyone at my "own" company as I am a remote employee and was hired on there in a merger type situation. AND I am getting ready to go on COBRA, lol. Twisted enough? Here is the wording of my insurance policy, under exclusions it contains: 9. Surgical and non-surgical treatment of obesity, including morbid obesity. This is a choice the "employer" (Administaff) has made, as I understand it. Since I am leaving (we are un-merging and I will be an independent contractor/self-employed) AND I know no one, I have NO pull on the employer side of things. When it is specifically EXCLUDED in the policy, if you submit a predetermination, I assume the answer is always no? Any advice/ideas? I don't have the money for self-pay but considering finding a way...just don't know whether this is a fight worth even taking up on the insurance side. My husband is a stay-at-home dad, so COBRA will be my only insurance choice until it runs out and I go on the state high-risk insurance. My BMI is 42.5 and I have hypertension, diabetes, and GERD. Have been overweight all my adult life and just keep creeping up the scale. I have not gained and lost weight over and over but after having each child I did get down somewhat and creep back up. So not a yo-yo dieter really, and no "documented" diet history either. Sorry this is so long.... Julie, age 37
We have many similar cir****tances with regard to our insurance situations.
Some of the best info I received on employer administered plans came from Paul. He has all the info on his website under "Self - insured (ERISA) employer exclusions". I have a new insurance policy now that doesn't contain any "discriminating" exclusions. Prior to that I paid a lot of money for COBRA benefits that were through my employer and contained a bariatric surgery exclusion. They excluded anything weight loss related - how helpful in a time when they are calling obesity an epidemic, right? Best, Sam
You see things; and you say 'Why?'
But I dream things that never were; and I say 'Why not?'
- George Bernard Shaw