Question:
Is it legal for an Ins. Co. to not insure you after the gastric bypass?

I have formed my own company with my husband and about to go off of COBRA. While trying to get insurance as an individual, I was told NO insurance company will touch me after the gastric bypass. We go through all the pain and trials to have the surgery to be more healthy and then this bomb happens! Help with any suggestions.    — Janis G. (posted on September 19, 2003)

September 19, 2003
I am not certain but I thought as long as you have no gap in coverage they had to take you? Also I know I can not increase my life insurance now that I have had it... I go through Farmers on that... I was very surprised...
   — MF

September 19, 2003
Yes, based on the HIPAA laws passed in (I believe) 1997, as long as you haven't had a gap of more than 30 or 60 days, you shouldn't be declined health insurance. Maybe they are playing games with you and think you won't know the "rules"...if I were you, I'd bring up the above legislation and see what they say then. Good luck.
   — Kamy

September 19, 2003
HIPAA is for group insurance. Individual policies can deny you coverage because of gastric bypass or any other conditions it sees fit. Examples: Heart Attack, angioplasty, bypass, most diabetes, recent DUI,even current pregnancy& present or severe varicose veins. To many others to list. You may want to check with your state. Indiana has a health pool people who are otherwise un-insurable for health can go to. Premiums are pretty steep but much better than nothing. HIPAA does apply to the state health pool. (Don't have to worry about pre-ex with proper proof of prior coverage.) Hope this helps. Best of luck! Kathleen
   — Kathleen R.

September 19, 2003
The HIPAA rules refered to by previous posters apply to GROUP insurance plans only. Individual policies are governed by state laws, and in most states, they may deny you coverage for any reason they want. Note that insurance companies frequently decline to write individual policies for people with all sorts of past health isuues (e.g. heart problems, cancer, and other chronic conditions), not just WLS. I, too, believe they're misguided in this exclusion, especially after two years post-op, but it is their right, in most cases. Note that if you were going onto a group plan (through an employer or some other group), then you could not be excluded for individual health issues.
   — Vespa R.

September 19, 2003
I went through this as my Cobra ran out. I went from a group plan to trying to find a individual plan as I am now self-employed. The HIPPA rules stated that because I had continuous coverage with no gaps that I COULD NOT be denied coverage! However, that doesn't keep the insurance companies from raising their rates as high as they can just because I've had a gastric bypass. I went from paying $150 a month for my husband and myself under my group plan for excellent coverage to $450/month under Cobra to $1200/month individual for half-ass coverage under Pacificare. Az BCBS wanted even more than that! I think it's criminal that they punish you for trying to get healthy.
   — LLinderman

September 19, 2003
I also just went through this. I had my surgery covered under COBRA in May. In July it was ready to run out. BC/BS sent me a form to fill out to then be transfered to another plan after COBRA. When I filled it out and listed that I had just had the surgery, they denied me. I went to the State Insurance Commission (CT) and they said that if I was in a group insurnace I would not be denied, but private insurance they can deny you for many reasons. So now I'm in that "high risk" pool for insurance paying $550 a month. They told me that after I'm out a year it will drop significantly, but for now I'm just screwed. Makes me happy that I got the $40,000 out of THEM for the surgery when I did!!!
   — Patricia G.