Starting a businness- small group health insurance
My husband is starting a small business (2 employees - me and him) and I'm looking into small group insurance. My problem is ALL the insurance companies have some sort of obesity or wt loss tx/therapy or surgery for wt loss/gain(I wish) in the general non-covered exclusion. I think I need to find out what exact wording I need to look for or find out if these are listed may they be overturned for medical necessity. A General Exclusion (non-covered) may be overturned for medical necessity.. I think?.. Unfortunately I'm not an insurance guru and there are so many wordings I don't know exactly what can be acceptable. Plus, I think since my husband is the employer he should be able to say what services he wishes to be included. And another thing, I am considered more than just obese so if it states obese as non-covered, does this also include morbid or super obesity? Anybody have any input?
Dear Gail:
I am still fighting with UniCare PPO Platinum which is a small group plan. It is now in the hands of the Attorney General's office of Illinois.
They state that they NEVER cover bariatric surgery for small groups or individuals even when medically necessary. They have agreed that it is medically necessary in my case, but say that they do not have to cover because there is a vague General Exclusion an all of their small group and individual policies. When I argue that the exclusion is worded poorly, they say it is standard wording and I should "just know" that they mean surgery. When I stated that I find it discriminatory that they will not cover this surgery even though THEY agree it is medically necessary, she actually said, "we don't cover hearing aids either, but we are not discriminating against deaf people."
My advise is to find a small group policy that does cover medically necessary bariatric surgery. My insurance broker says that the only company that she knows of that covers for a small group is Blue Cross/Blue Shield, which we may have to sign up for when we look into renewal or change of companies in the fall.
From all that I have been reading on these boards, you must start now visiting your primary care doctor monthly to document your inability to lose weight any other way. Some say they require 6 months, and some say 12. If they require 12 months, and the policy renews every 12 months, they have a good chance that you will change insurance companies after your 12 months is up. It seems to be a big scam.
If we DO change insurance companies (again) then UniCare wins. I (and my doctor) believe that they are just fighting to drag it out so that we do change companies and they will get out of paying that way. The woman in charge of small group claims actually told me to take our business elsewhere because our premium money meant nothing to UniCare. We have tried to purchase a rider or offered to purchase a policy that covers, but they refuse.
I will let you (and everyone else on this board) know how it all turns out in the end. Please do the same and post your solution on the board. You can try to email me, but they only come through occasionally.
Good luck!!!
Dawn