Insurance questions (getting insurance after the band)

[california-rais 0]

Hello,

I'm a Canadian, who was banded in the United States 4 years ago. I'm a young guy, 28 yo, perfectly healthy, BMI is 27!!!! I have no complications from the surgery.

I will be moving to California in September and need to get health insurance! My question is, if my employer doesnt cover my insurance, will I be able to get individual coverage??? I called Aetna and they said that anyone with a lap-band is an instant denial?

How do most insurance companies work with getting insurance if you already have a lap band?

Thanks a lot

[Melissa Lea 1]

Hummm, this is the first that I have heard of an insurance company denying benefits to overall healthcare for a person with the band. I can understand perhaps if it's anything band related. If they deny the band then you think they would have to deny people with RNY and people with other procedures (breast implants, etc) --all FDA approved.

I hope someone will have some answers ....very interesting topic. That's something I don't think anyone really thinks about going into our procedures.

Melissa Lea

[Alexandra 55]

These rules vary considerably from state to state. I doubt California allows that sort of exclusion, but you'd have to check with the insurance laws in that state to be sure. (I just checked out the Blue Cross of CA website and they are actively marketing individual insurance. There is medical underwriting, which means they can decide to charge people more who have significant medical conditions, but they DO cover treatment for morbid obesity so they probably don't exclude people on that basis.)

Visit bluecrossca.com for more information.

[california-rais 0]

Hey,

just called bluecross, they also said any weightloss surgery is usually an "instant denial"...

[nursekathy2u 0]

I called Aetna and they said anyone with a lap-band is an instant denial?

How do most insurance companies work with getting insurance if you already have a lap band?

Thanks a lot

Aetna only started covering Lap Bands in March.. At least thats the way it was in Texas. If you havent checked with them since march you might call and ask again.

[Alexandra 55]

Hey,

just called bluecross, they also said any weightloss surgery is usually an "instant denial"...

Then you should call the department of insurance or the department that manages HMOs in California. I'm sure the person you spoke with was giving you the party-line reaction to RNY surgery, and it may be that the medical underwriters take a different approach to banding. Find out what the law says they can and cannot write out.

You really just won't know until you apply. No one is going to give you a blanket *yes* or *no* beforehand. If the state doesn't have rules of guaranteed issue individual health insurance (like NJ does), they can exclude for medical reasons. But the BCBSCA website made it look like there would be other options even so, whether it be higher premiums or condition exclusions or whatever.

[Tricia K. 0]

FYI - I live in Louisiana and have been denied individual coverage from 3 different companies because I had lap band surgery.

Blue Cross Blue Shield of Louisiana did say that I could re-apply after my 1 year bandiversary and they would consider me again.

The other 2 flat out said that they will not cover me because I've had the surgery, regardless of how much time it has been. This was after I went through the application process, not from a simple phone call.

[california-rais 0]

Well, I've sent in applications to a few of the major insurance providers.... I really hope I can get insurance, otherwise I'm going to have to reconsider my decision to move to California.

The situation in Louisiana sounds awful and unreasonable.

[nursekathy2u 0]

WOW... this is very surprising to me.. it seems the pts with revisions etc. are far out numbered by the patients who resolve most of their co-morbidities.. That is with lap bands and gastric bypasses anyway. I dont know enough about the other weight loss surgeries to comment. I would think it would be less expensive to cover a person with a lap band that requires periodic fills and has one or 2 co-mordidities than it would to cover a 250lb diabetic with heart disease, high blood pressure, sleep apnea, back pain, etc. Just doesnt make sense.. another form of discrimination against the morbidly obese.

[california-rais 0]

Good point. Except I'm no longer morbidly obese! I'm BARELY considered "Slightly overweight"!! I have never had a comorbidity from obesity either - no high blood pressure, normal cholesterol, no sleap apnea, no joint/muscle problems..

I can understand the insurance company not wanting to cover the fills or any gastrointestinal problems that may arrise from the band.

However, not covering my overall health??? I think thats way to crazy. On Monday, I'm going to call the state insurance review board and ask them more questions.

I'm also worried about ever moving to a different state, and having to do the procedure of hunting for health insurance.

[nursekathy2u 0]

I moved this post.. I meant to start a new thread...

[Alexandra 55]

I can understand the insurance company not wanting to cover the fills or any gastrointestinal problems that may arrise from the band.

However, not covering my overall health??? I think thats way to crazy. On Monday, I'm going to call the state insurance review board and ask them more questions.

I'm also worried about ever moving to a different state, and having to do the procedure of hunting for health insurance.

I'd be willing to bet that BCBSCA will cover you, but maybe after a year or two has passed since surgery. And they might want to exclude complications related to surgery. But I agree, your overall health has improved to the extent that you should be insurable.

Also, not every state has this type of medical underwriting. New Jersey and New York have guaranteed-issue individual health policies, for which you cannot be turned down. I swear, the range of rules about this sort of thing is horrific, and what makes ANY conversation about "national health insurance" an utter joke. Unless a decision is made in Washington to standardize health insurance rules from state to state, it will never get any better. :angry (Pet peeve of mine, can ya tell?)

[HunnyBun 2]

How do they know if you've had the procedure? Do they simply ask or do insurance companies have access to people's medical recs. Isn't HIPAA supposed to protect our med recs?

I am not in the medical field so I don't know much about this.

[Melissa Lea 1]

Well, I am a self pay patient because my insurance had an "exclusion". Since I was self pay, I never needed my PCP referral for the procedure. Think I will not say anything to prevent it from being documented in my medical record until this insurance stuff gets straightened out. Really sad that some companys approve for you to have the procedure then deny you care if you move/change.

Melissa Lea

[BeacheeGirl 0]

Wow, *bumpo* Melissa Lea, I think I will leave that out of my records too since I'm lucky enough to be covered by my companies insurance automatically but you never know what the future holds where I might have to pay for my own....