Fear About Potential Loss Of Bariatric Coverage

[mrsto 2,925]

I know this has been discussed at some point, but I want to address it again…..

I've been having bits of fleeing panic over the idea that I (we) can lose bariatric coverage with all the health insurance changes coming down the pike. I'm safe for 2014, but what happens after that? My fear is, if I lose bariatric coverage, and have issues that require surgical intervention, how will I pay for it? This scares the crap out of me, and I'm thinking……if I do lose the coverage, I may just have the surgery reversed prior to that happening. And that in itself is a scary proposition!

There are still many unknowns with the current flux in the healthcare system. I've heard a few people post that they've already lost their bariatric coverage…..and what will they do?? I'd love to hear your thoughts on this. I'm not posting this to open up another political discussion on the Affordable Health Care Act. I'm genuinely interested to hear what others plans are, should they lose this coverage.

[DELETE THIS ACCOUNT! 12,703]

I have thought about the same thing and often. I'm at a loss. I don't won't to ever lose my band because I've had tremendous success with it. But, the thought of having it without insurance coverage to adequately care for it terrifies me.

I see a lot of self pay people and people who've lost their coverage who talk about going years without a check because they can't afford it. When they finally go back in, they have bad complications and slips because of poor after care.

After care with the band is crucial. I'm not sure what I'll do I'd I lose coverage for it. Do I get it removed? Revise to the Sleeve? I honestly don't know. I only know it would force me to make some really hard decisions.

[mrsto 2,925]

I've said all along, that I wouldn't have a revision if I lost my band. But now? I don't even know what the sleeve would be like after plication. Or if it's even possible.

I have a lot to address with my doctor at my next visit. I want his take on the whole health insurance issue, and if there might be a way around it. A big question in my mind is, if new insurance is supposed to cover pre-existing conditions, would our surgeries be covered under that caveat? If we had a serious complication that required removal of the band, wouldn't that be considered "pre-existing"?

Geez……so much to think about. I don't know that we'll get definitive answers, either. Last night……as I lay awake at 3am…..Thanksgiving sugar cursing through my veins, I was having a bit of meltdown on this. I really did a number on myself with all the possibilities, in addition to wondering how the hell I let myself eat too much crap. Okay…..it was a holiday…..I'm moving on

[B-52 7,113]

I rely upon insurance re-imbursements for all our cash flow.....

Whatever you may fear for the future, it is already taking place.....right now all insurance carriers are getting real tight about what they will approve and npot approve, and what they are willing to pay...everyone I talk to says it is getting absolutely crazy...

It is as though Insurance co.'s are "Circleing The Wagons" in defence.....

There is a lot of talk currently going on about buying into the new health plans offered by Obama Care....the one thing no one is saying, but everyone on my side of it are talking about, is "WHAT ARE YOU BUYING?" Do you know if it will be any good?

No One knows for sure because it is not really implemented in force....there is speculation it will be worse than Medicare, another federal health program, and THAT is pretty bad....

Recent Poll conducted in New York found that 80% of Dr.'s polled will not participate in the new Federal Exchanges....

They may say they will approve something, and agree to pay...but what are they going to pay??? What the Dr. charges? I think not.....

Example, you need surgery, and the cost will be $5000....Insurance will approve and pay, but they will be willing to pay only $2500...keep costs down to stay within a federal budget....

So now you are going to have to find a Dr. willing to do the surgery for 1/2 the price...good luck with that..and when you do find one, you may not want him/her coming near you....

And believe me...Talk is Cheap....they may tell you they will cover certain things, but do THEY even understand what they're saying????

Experience dealing with the Federal Medicare Codes cleary answers that question as "No, They do Not!"

So hold on, it is going to get a lot worse, then take years to straighten out, if they ever do....

IMO, if you have good insurance now, do not delay having certain procedures done....

[Angi281 77]

I rely upon insurance re-imbursements for all our cash flow.....

Whatever you may fear for the future, it is already taking place.....right now all insurance carriers are getting real tight about what they will approve and npot approve, and what they are willing to pay...everyone I talk to says it is getting absolutely crazy...

It is as though Insurance co.'s are "Circleing The Wagons" in defence.....

There is a lot of talk currently going on about buying into the new health plans offered by Obama Care....the one thing no one is saying, but everyone on my side of it are talking about, is "WHAT ARE YOU BUYING?" Do you know if it will be any good?

No One knows for sure because it is not really implemented in force....there is speculation it will be worse than Medicare, another federal health program, and THAT is pretty bad....

Recent Poll conducted in New York found that 80% of Dr.'s polled will not participate in the new Federal Exchanges....

They may say they will approve something, and agree to pay...but what are they going to pay??? What the Dr. charges? I think not.....

Example, you need surgery, and the cost will be $5000....Insurance will approve and pay, but they will be willing to pay only $2500...keep costs down to stay within a federal budget....

So now you are going to have to find a Dr. willing to do the surgery for 1/2 the price...good luck with that..and when you do find one, you may not want him/her coming near you....

And believe me...Talk is Cheap....they may tell you they will cover certain things, but do THEY even understand what they're saying????

Experience dealing with the Federal Medicare Codes cleary answers that question as "No, They do Not!"

So hold on, it is going to get a lot worse, then take years to straighten out, if they ever do....

IMO, if you have good insurance now, do not delay having certain procedures done....

I wouldn't panic about that yet. If it's like that then its like an H.M.O, H.M.O's only pay an agreed upon price for example my hospital care cost $24500 my insurance paid $12250. My cost is my $250 deductible. These doctors are all familiar with that kind of pay scale. I imagine the new system with operate with agreed upon prices similar to an H.M.O

[Terry Poperszky 2,784]

I'm self-pay, my insurance company wanted me to spend 5K non-reimbursable and do a 12 mont supervised diet for an 11K procedure, which is essentially no bariatric coverage IMHO. I got a year of fills with the procedure, and that is up next month, but I am in the green zone, and should stay there. When it is up, I will pay for a fill, even if I have to save up for it. Remove my band? Not gonna happen. If the band ever fails, I will cross that road when I come to it.

There is a lot of fear right now, I personally think it is all going to be OK.

[☠carolinagirl☠ 18,722]

i read these posts and can never make heads or tales of all this stuff..

very confusing to a simple country girl let me tell you....i just wanted to say try not to worry until one knows for sure..easier said then done.

[catfish87 3,471]

I've had employer paid ( at least a portion of it ) health insurance for over 20 years now. And something about the coverage changes almost every year. I think you just deal with it as it comes.... kinda like life.

[mrsto 2,925]

I can deal with most of whatever comes with the new healthcare system. But taking away bariatric coverage isn't something I can deal with. I do not have the resources to pay for a huge surgery out of pocket. When I called my doctor's office to discuss this with the insurance person, the first thing out of her mouth was that the insurance companies are taking out the coverage. They can work with patients on costs, but the hospital is the issue. They will not budge, and they are the biggest part of the expense. My hospital bill was something like $70K, for one night stay. Sickening, but it is what it is. And that doesn't include the surgeon, anesthesiologist, radiologist, etc. Ugh...

All of you are right……to cross that path when the time comes. But all of these unknowns is cause for concern. I love my band, but keeping something that could ultimately financially break me, isn't something I'm going to do so close to retirement.

[B-52 7,113]

The question is NOT if a insurance policy will approve the surgery, it is will the Insurance policy cover the cost? What is the allowable?

Dr.'s will choose what plans they want to participate in, or not, based upon covering their costs....

You may be able to get Bariatric coverage, but you may not care for the Dr.'s wiling to participate in it...sometimes you do get what you pay for....and we already learned keeping your old Dr. with this new plan is a lie....

Many Dr.'s are choosing to drop Medicare, another Federal program because of low reimbursements.....is this new law going to be more efficient than medicare??

If you know anything about the Medicare system, hold onto your hats !!!! It's going to get very interesting to say the least...

My Wife is the Director of a large Rehab facility....they have been trying to get answers as to what the guidelines will be for services...they cannot get a straight answer!!! All they are being told is "Don't worry...it's covered" What's covered? How Long? Who Qualifies?

They don't have the answers...it is as if they're making it up as they go along, just like the website...

So her facility has no choice but to refuse to admit patients until they get some straight answers....less patients means more layoffs of staff, etc....

Edited December 9, 2013 by B-52

[mrsto 2,925]

B-52 - It's some scary sh-t. So many GOOD doctors are opting out of accepting insurance, period! I refuse to go to Mexico for anything band related, so for me, if/when I lose the coverage, out comes the band. I can afford paying $250 for a fill, but I can't afford anything to do with complications. Moving forward into such mirky waters, isn't a risk I'm willing to take. I have enough stress!!

For today, what I DO know, is that I have bariatric coverage for the next 12 months. What will happen beyond that, I have no idea. As the insurance person in my doc's office said, just wait until next October before freaking out. That is when the new "choices" roll out from the County of Los Angeles (my husband's employer). If we're able to keep what we've got, great. And at that point I'll make sure my doctor and his hospital still accepts that coverage…... SAME as they always have. If not, I'll have some very hard decisions to make.

Edited December 9, 2013 by mrsto