Question:
Turned down for insurance coverage due to having had Gastric Bypass Surgery

I applied for an individual policy through Blue Shield and was turned down. The reason that they gave me was that I had had Gastric Bypass surgery 4 years ago. Blue Shield is one of the leading insurance companies paying for this surgery yet they turned me down because I had it done. Has anyone had this happen to them? Is there any recourse?    — ssmoody (posted on October 24, 2006)

October 24, 2006
I also had this happen. My husband retired and my insurance ran out last December. No one would insure me due to having GBS. However, there is a BCBS open enrollment in my state at this time. I now have insurance. If your state is doing an open enrollment try to enroll. Otherwise, I wish you the very best. Carmen
   — Carmen G.

October 24, 2006
welcome to the reality of WLS post op-medical insurance wise. i had surgery 2.5 yrs ago, and a week later, my medical ins had stopped-at that time I was told by countless insurance companies, I could either start to work for someone and get the insurance by open enrollment-which they couldnt deny, or I would have to wait a period of 2 years without any post WLS complications. Well its been 2 years, and I havent tried to get ins because the cost of a private account is prohibitive. I wish you luck- they just dont get it do they-we had the surgery, we are healthier now than ever, our co-morbs are gone, and it will cost their ins companies less to have us as clients-someone needs to wake these people up to the realities-meanwhile those of us without ins take the brunt because we have to overpay in cash for what should be ours by right. Hang in there and good luck Cindi -230#
   — DollyDoodles

October 25, 2006
Know how you feel ! I am self employed am have to buy my own insurance and in the past was always rated highrsk only becuase of my weight! not other issues...no high blood pressure, sleep apena, etc... just the weight so I didn't have insurance cause the high risk insurance was too too expensive $750. a month for 1 person who never was ill. any way i paid cash for my gastric bypas 1 yr ago and have over a lost 100 pounds and now am at a weight / ratio that the insurance companies conside acceptable to not be high risk but can't get anyone to insure me because i had the gastric bypass. Go figuire . i had the surgery to lose the weight to get the insure but now no one will give it to me, unless I am in a group insurance situation which doesn't fit when you are self employed. I'm looking for anwsers too! Janet
   — jpcal

October 26, 2006
I was uninsurable before surgery due to my weight and now am uninsurable because of WLS. It's a rock and a hard place, for sure. However, you should check with your state and see if they have a special policy for "uninsurables"... since BC/BS turned me down (told me to check again in 5 years!). I now qualify for a special coverage supplemented by the state of Colorado called "Cover Colorado". It's almost $500/month just for me, but after one bout with kidney stones that cost me close to $20,000, I'm convinced that it's a necessary evil. Good luck, I hope you find something. -- Of course, the only other option is getting group insurance; which means you or your spouse working for a company that offers such a program.
   — [Deactivated Member]

October 27, 2006
I just had the same thing happen to me. BCBS wants me to sign a waiver saying that they would not cover anything related to the Gastic Bypass surgery. My My! I am almost 3 years out and BCBS paid for my surgery in Feb. 2003. Now they don't want cover me? I have had no complications so far. I had my gallbladder out at the time of the gastric surgery. So what if I did come up with a stomach ulcer or something to that effect. I guess that would mean I got an ulcer from having the surgery. I think not!! Needless to say, the insurance company wins because I will not sign the waiver. My company is going to try and go on a group plan this January. I just hope nothing happens to me between now and then. Good Luck!
   — jfwilson1958

November 14, 2006
Was the gastric bypass all that was noted for the rejection? If so, I'd sit down and write a request for appeal. My rebuttal would indicate that by my choosing gastric bypass surgery I have lowered my risk for comorbidities such as diabetes, high blood pressure, high cholesterol, knee and hip replacements, etc., etc., and that should be considered (by an insurer) an asset, not a hinderance to securing coverage. Then I would indicate that unless their initial decision is reversed, I would be considering a claim with the Insurance Commissioner relative to a perceived prejudice against someone who was was overweight. See what that gets you!
   — sby949