Advice on Purchasing Individual Insurance?/Carefirst BCBS

Hi All, I have Unicare NCPPO (through my employer)and it seems that there is a strong possibility they may not cover WLS. I'm going to fight for it, but I want to have a plan B in case things don't work out. I'm not panicking yet because I am just starting my 6 mos. supervised weight loss plan. But I will have this surgery in 2005. So I am considering purchasing another policy, probably Carefirst BCBS of Maryland and applying through them in a few months. Would there be any reason besides the cost , that this wouldn't work? Also if anyone has this insurance, how has the approval process been? I read the other post on AL. Seems like things will get tight for those of us hoping to be re-born in 2005. Two years ago my co-workers basically just called the insurance company and told them I want surgery and that was it. Boy have time changed....

I wasn't sure if you knew about the laws in MD regarding WLS. Apparently they have quite a few loopholes for small employers and for policies written out of state, but if the insurer falls within the requirements, there is a MD law that requires that they provide it if you meet their requirements. I recommend that you read your insurers policy and clinical policy bulletin thoroughly. On the other hand, they do seem to throw up every possible obstacle. I am waiting on approval from Aetna, and starting a 6 month diet again - Like this ones going to work better than any of the others! I am doing the paperwork to hire Gary to see if that will help things along. Do I really need to lose and gain more again? Aetna seems to reject many of my familiy's claims at random, and I recently had to appeal for the removal of pre-cancerous lesions -did they want to wait until they spread? I have read my policy book from cover to cover, as well as the clinical policy bulletin. I would love to have the lap-band, but dont want to do it out of pocket. I did see on the lap-band board that there is a Dr. who does it in OHIO for around 12K. I don't have any experience w/ Blue Cross, but you should be able to find links regarding the Maryland laws pretty easily. Hope this helps.

Connie, Thanks so much for this reply. I have vaguely heard of this law and now I know that I need to research it more thoroughly and use it to fight my primary insurance company. When I talked to the broker that sold my company the insurance, she did say something about them only covering surgeries if they were medically necessary. So I guess the fight will be proving that it is medically necessary. With a BMI of 53, possibly arthritis in my knees, and a history of hypertension all at 27, you would think that wouldn't be hard. But I know it will be. I really wish you all the best with your fight with Aetna. I feel your frustration. I wish I had been ready two years ago when it was easier. Shoulda, would, coulda.... Again, thanks and Happy Thanksgiving