Question:
Is my situation hopeless? Confusion RE: Insurance and Cobra

I am 18 years old and over 400+lbs. I have sought Bariatric surgery for 2 years now, spending the last year fighting and repeatedly losing the battles with my Insurance companies exclusion. Its iron clad. They absolutely will not cover WLS. One road block after another presents itself and I'm tired of it! The latest and the reason behind my post today: I am trying to purchase Individual health insurance. But because of my weight, NO insurance company will accept me. I was told my only shot would be to apply during Open Enrollment, but as I have just found out, apparently, I cannot apply for Open Enrollment until I exhaust the COBRA continuation of my insurance (through my parents self insured employer) for 3 YEARS. Meaning, I have to stick with this insurance for 3 years before I am able to change insurance and have a shot at surgery!?! I'm getting desperate and feeling above all else, hopeless, and tired of fighting. How can I get around this Continuation coverage and get an individual plan? Someone, please help me out here, I would appreciate it so incredibly much. [email protected]    — amie (posted on June 24, 2003)

June 23, 2003
Hi I am sorry about your situation....Idont know if youwork or not, but I do know that the BCBS that Home Depot employees have pays for surgery...Its definatly worth getting a job that you know will pay for surgery. Maybe you can call your surgeons office to get some ideas of employers in your area. Good Luck
   — Mandybub

June 23, 2003
I don't know who's telling you this, but I think they're wrong. COBRA is usually good for only 18 months. Also, if you have or can get other insurance, then you aren't eligible for COBRA any longer. I was covered under my ex-husband's plan when we were still married, but I was also covered under my own employer. When he got laid off, he was eligible for COBRA, but I had to drop out of his employer's plan immediately. One thing to try is to call your state's insurance department. Look in the blue pages of the phone book or go to www.xxxxxxxx.gov, where you should replace the x's with your state's full name. Most state web sites have a search engine, so you could do a search on insurance and find it that way.
   — garw

June 24, 2003
Chances are if your 'overweight' it will be HARD to impossi ble to be 'private' insurance. as far as the 'open enrollment' this sounds like a 'state' policy. ONE good way, is to 'get a job' that has 'group' insurance. Once you are employed with coverage; your cobra would discontinue. (as for cobra - normal cobra is 18 months for 'employee's 36 months for dependants.) Since your on cobra at 18 I take it you are no longer a full time student.
   — star .

June 24, 2003
You may want to consult an attorney that specializes in labor law, that could examine the exclusion clause, to see if there may be a claim for discriminiation based on the federal ADA. The federal government has now viewed obesity as a disease, hence the relaxerd position of the IRS for deducting weight loss costs. An attorney may be able to pressure the insurance company to revise its exclusionary policy to "medically necessary" in accordance with NIH guidelines. Also, you may want to visit a web site that has information regarding the law, health insurance, and obesity, such as www.obesitylaw.com Regarding a private or individual insurance policy, be aware that if you were to find one, it likely will exclude pre-existing conditions. Also, an insurance company would be suspicious of a new enrollee seeking approval for WLS immediately after purchasing a policy. I would really suggest that you either consult hte above web site or an attorney. As an outside shot, you may wantt to contact your state's insurance department or whatever department regulates health insurance providers in your state. The correct web site address for states is www.state.XX.us, your state's abbreviation replaces the XX, such as www.state.nj.us for New Jersey. good luck.
   — David F.

June 24, 2003
I'm an insurance agent and what you are being told is correct. The new federal law HIPPA says insurance companies must offer you the same coverage as any other client, but at an appropriate rate, when you are "eligible". You are only "eligible" for a decent policy once you exhaust your 3 years of cobra. I go along with the other's here.....get a job that has good insurance and where you know the surgery is covered. Oh, and if you don't want to work or need to, once you are covered on the insurance with the new employer for at least one day, if you quit they must offer you cobra for up to 18 months. So, you might not have to work long to get on the policy. Remember, only companies with 20+ employees must offer cobra. Home Depot sounds like a good idea!
   — Sharon B.

June 24, 2003
Thanks to everyone who has responded, I truly appreciate it. We again called the insurance company that I am attempting to apply to and the situation was sorted out ( a little) We were told by the woman we spoke to that it's not mandatory for me to go through the 3 years of COBRA to be considered Federally Eligible (and therefore immediately offered a policy) She said that only if I had elected the COBRA continued coverage would I then have to wait out the 3 years. Does this sound correct to everyone else? it seems I read one thing and then am told another. VERY confusing! I also unfortunately cannot get a job. I just graduated from High School, will start College next Spring (delayed fall admission to allow for surgery and recovery time) I cannot see anyone hiring me at this weight, and the largest obstacle is the fact I cannot drive (due to my weight) and I live in very rural Ohio (an Amish buggy is passing my house as I type this) I'm kind of stuck out here. Hopefully this will be sorted out soon! Thanks again to all who replied. And also, to answer the question RE: 3 years of coverage: Because I am a dependant under my parents policy I am eligible for 36 months of COBRA continuation as opposed to the normal 18 month continuation.
   — amie