Question:
Need advice on whether to switch insurance carriers after having intial consultation.

At my job we have 1 month to make a decision about the type of insurance coverage we will have for the next year. My current insurance is GA State Merit & morbid obesity is excluded in their policy. I have received no denial yet, but I have talked with them on the phone & was told that weight loss surgery would not be covered. We have a choice of Aetna Us Healthcare, AUSHC CCO, Bluechoice/CCO, Or Kaiser Permanente/CCO. From the research I have done on this site Aetna has covered or will cover weight loss surgery,but will they consider my weight to be a pre-existing condition. Also could they refuse to cover me because of my present weight or medical problems. If I change coverages & then they refuse to accept me then I will be in a position where I might not have any insurance due to attempting to change to a new company who I feel may cover the weight loss. Please offer any advice that you feel may help including whether to go with a PPO,HMO CCO, or whether I should wait to hear in writing from my current insurance (State Merit). Thanks!    — [Anonymous] (posted on April 16, 2000)

April 16, 2000
I would first check with your employer. They contract with the insurance carriers and will know about pre-existing conditions - waiting period, etc. Many employers are insured under a group program - everyone has equal access to health care regardless of medical history or existing conditions. You may want to further explore whether the plan being advertised has an exclusion for WLS. This can be obtained by calling the carrier or asking your employer. [email protected]
   — Shauntay

April 16, 2000
I just want you to be aware, that United Healthcare does have policies with exclusion clauses. I know because I have one of these policies and I am in the proccess of trying to find out the exact wording of the exclusion clause to see if I can get around it. Also, I belive that if you are switiching from one insurance to another then pre existing usually does not apply. But please check into it. Good Luck! [email protected]
   — Kallie H.

April 16, 2000
To my knowledge it is not pre-exsisting if you go from one ins to another within the same employer and as long as the ins does not lapse longer than 60 days. Often we have patients denied with one ins and then when open enrollment comes around they change ins and hope on getting the approval with the second ins. My advice would be to switch to Aetna especially if you know the ins you have now does not cover the procedure. Aetna is very good, I had them when I had my surgery. Good Luck!!!
   — Julie H.

April 17, 2000
I too had an insurance with an exclusion when I began to look at wls. After finding out my choices I called the member services area of each company found out what the specific policy was regarding wls. If the company covered the surgery if medically necessary I asked what was the medical criteria for approval. Each company was very cooperative and I was approved within a week of my PCP's request being received by my new insurance company. It CAN NOT HURT TO ASK. Good luck.
   — BOB J.