Question:
My insurance changes July 1, the new one doesn't cover WLS, What do I do?

My insurance changes July 1 from Aetna to Regence Blue Cross. Regence Blue Cross has never paid for WLS that I know of. We just purchased a home so not enough equity to cover the cost. All my pre-ops were completed the end of May. Just waiting for the Dr's Office to submit to insurance for approval. What if WLS is out for me? Is there any hope? Thanks for your reply.    — Cari F. (posted on June 14, 2002)

June 14, 2002
The only option that I can think of for you would be to request "Transition of Care" paperwork from the new carrier. This would allow you to continue any treatment already started w/your new insurance carrier. I would also suggest having your doctor send for approval to Aetna ASAP. This way, you'll definately have a better chance of qualifying for Transition of Care. You can also notify your new carrier that treatment was previously approved (if it is by the time your change carriers), make sure you check you new plans exclusions to find out if WLS is covered. I hope this helps!
   — Rosario T.

June 14, 2002
I may be completely wrong here, but I am pretty sure that someone here in my company had the same type question (different surgery) and was told as long as there wasn't a laspe of 60 some odd days, then they are supposed to view it as the original insurance company had. This seems especially good since you have alreayd had all of your pre-op things done. I know you have to give the new company your "certificate of coverage" which the old company is supposed to give you once your insurance with them is terminated. I hope this helps. Best of luck!
   — karmiausnic

June 14, 2002
I had something similar happen to me at the end of last year. I had already been approved when it happened though - my problem was getting the surgery done before my insurance switched. I accomplished this by switching surgeons. The transition of care some folks mentioned did not apply in my case - my new insurance (BC/BS-PPO) only accepted a transition if it was for something like chemotherapy or dialysis. My situation was considered pre-op testing completed for surgery -- the tests did not have to be repeated but I would have had to submit to the approval process all over again. Because your surgeon has not even submitted for approval from your company, you may be in for an uphill battle. I'm not sure but I don't think you can pick up COBRA coverage if other insurance coverage is available to you. Have you called the new insurance company and explained the situation to them? Have you spoken to your company's Human Resources Department? Would your surgeon be willing to get off the stick and get those forms in to Aetna on Monday and then, hopefully, get you scheduled IMMEDIATELY upon their approval (I think Aetna is usually pretty quick with their responses.)? Don't give up -- I didn't and I'm SO glad I didn't. I ended up being discharged from the hospital on 1/1/02 - technically under my new insurance, but my old insurance picked it up without a fight and have paid the hospital's claim. I wish you luck!
   — Pam S.