Question:
What are my chances of collecting STD after surgery?

My company does offer short term disabiliy benefits. The company pays premiums after one year of full time service, but employees can opt to pay premiums for the first year. I have chosen to do so. However my question is: how likely is it that the insurance company will approve the 4-6 weeks my surgeon has told me I will need to take off from work? Do insurance companies often just refuse to cover re-coop time after WLS? My health insurance will pay for my surgery, but it is not through my work, it is from my husbands work. Also, if I contact HR with this question, can they just use the advance notice to "get their ducks in a row" to have a plausible reason to deny coverage? Coleen L.    — comala (posted on November 1, 2008)

November 1, 2008
Hi Coleen - I'm not an expert, but I believe any condition in which you cannot work is considered STD. I don't believe it will make any difference what procedure is done. If you have a doctor verifying that you're having surgery and what the expected out of work time is, I think they will approve. Therese
   — Therese W.

November 1, 2008
Hi Coleen, I was a STD benefits specialist with Guardian Life Insurance for many years. Not all conditions are necessarily payable under STD regardless of whether your doctor says you can't work. When your surgeon certifies the disability on your claim form, the insurance company will review the information and verify that you are unable to perform YOUR specific job duties. WLS is a qualifying condition and you will not be denied because of medical necessity like a regular medical insurance policy. In all my years in the industry, I have never once seen a STD claim initially denied because the disability was due to WLS. Any surgery usually automatically qualifies you for the standard post op recovery period as stipulated by the AMA guidelines that all insurance companies follow. To clarify, WLS may have a standard recovery period of 4-6 as per AMA guidelines so you will be approved to collect benefits for that amount of time but if the surgeon extends the disabilty to just say 8 or 10 weeks then he may need to submit proof that you are still disabled and this would include sending in your medical records to show that you had a complication you're still recovering from, etc. Whether he needs to submit medicals records and proof of disability will depend on how long he's extending the disability period. As far as your job is concerned, you are protected under the HIPPA law and neither you or your surgeon need to provide certain specific details regarding your health condition. The only information they are legally permitted to have is the date your disability began, length of time the doctor is certifying your disability and when he is releasing you to go back to work. They are not entitled to know the exact diagnosis, any surgery you had, any medications you are on etc and the insurance company will not disclose this information to them either if they were to call them. Also, they do not approve or deny your claim. They have no say in whether you qualify or not unless it's a privately funded plan and the insurance company is just acting as an administrator for them. This is usually the case for union plans. Just a bit of advice though - you may want to contact the insurance company and find out if there is a pre-existing condition clause on the policy. If there is, then there is a possibility of your claim being denied if you had even 1 office visit with a doctor in regards to having the surgery within a certain time frame prior to becoming disabled. It's usually 3 months prior to your effective date unless you were covered under another STD policy for 12 consecutive months. I know this can be very confusing so if you have any questions or need clarification, you can PM me and I'll be more than happy to help you. Good Luck! Valerie
   — [Deactivated Member]

November 1, 2008
I am sch for the lap band on 12/5 and i will get STD for the time I am off. My company use a sep insurance comp to handle our STD and FMLA. I just need to make sure all of the paper work from my doc is faxed to the insurance comp by 11/4.
   — sawwas

November 2, 2008
Hi Colleen, I went on FMLA with Short Term Disability, The company is separate from the insurance (medical dental optical we have) The policy for my company is after 7 day period of no benefits ( payments) I will recieve 70% of full time pay. They did tax me at higher rate as if it was a bonus check. My insurance premiums are not taken out until I return to work, which then were double up to get me up to date. i was approved for 4 weeks off, The FMLA gives you security in that they cannot balk at you taking time off, provided you have a MD who will fill out the paperwork needed. My surgery was covered through my husband's insurance, but I do have optical and dental with my own job. If you can take the time off, you will do better on the job when you return healed and in good shape for the full days work. Find out who handles the FMLA - short term disability claims for your company and call them. Mine wanted to mail me forms for my doctor I had them fax to the doctor instead. Be prepared to wait for your checks, my checks took 3 weeks to get to me and they paid me weekly. But I was happy to be paid at all. Best wishes to you. Cathy
   — Cat C

November 3, 2008
Hi Colleen, I had rny on oct 9th. I had planned to take 3-4 weeks off and had plenty of sick leave and vacation time to more than cover that. However, I was going bonkers at home and was actually back at work on the 21st. You might get lucky and recover fast and be ready to be back at work faster than you think. Just walk walk walk and walk some more after surgery. Good Luck
   — Esquir

November 3, 2008
Thanks, everyone for the great help. I was doubltful that I would need 4-6 weeks, as my surgeon suggests, but from what the nurse in his office says, just getting in the fluids and protein according to the schedule they give us to follow is like a full time job in itself! We'll see, that may be the hardest part. Again, thanks.
   — comala