Hi team!

I'm moving forward with a revision surgery (lap band to sleeve) but will need different insurance. I have a small business and already have an out of network PCP whom I ADORE.

Does anyone have any recommendations about insurance through the exchanges? Or an insurance they wouldn't recommend? I'm looking specifically for an insurance that has the "fewest hoops" to jump through.

I live in Northern California and will be having the surgery with Palo Alto Medical Group.

Any help is greatly appreciated! Thank you!!!!

Sheila

Go with B/C B/S . Every one takes it.

Kaiser Permanente has an entire Bariatric Center in CA. I know because I had KP in GA but was not covered under Obamacare.

BTW, I now have Humana under Obamacare and approval was breeze!

Best of luck to you!

Hi team!

I'm moving forward with a revision surgery (lap band to sleeve) but will need different insurance. I have a small business and already have an out of network PCP whom I ADORE.

Does anyone have any recommendations about insurance through the exchanges? Or an insurance they wouldn't recommend? I'm looking specifically for an insurance that has the "fewest hoops" to jump through.

I live in Northern California and will be having the surgery with Palo Alto Medical Group.

Any help is greatly appreciated! Thank you!!!!

Sheila

I would call and talk to the bariatric coordinator at El Camino hospital - that's where Pamf does it's WLS. She probably knows the best plans. I just had my VGS done by one of their best - no complaints. Pm me if you want more details.

Who's your surgeon? I'm at pamf too.

I would pick 2-3 options and then start making phone calls and googling.

Questions you'll want to ask:

1. Is the plan offered through the exchange going to cover WLS?

2. Can you send me the medical policy for that specific exchange plan in writing?

3. If that plan does not cover WLS, which plans do you offer to an individual that will and what is the cost?

To my knowledge, there are no HCA plans that cover bariatric services. At least in GA they do not. Make sure you read the plans carefully before you choose.

Edit.....I stand corrected...

http://www.bariatric-surgery-source.com/obamacare-weight-loss-surgery.html

Edited October 22, 201411 yr by ochiatl

Greetings Everyone,

WLS IS covered under the Affordable Healthcare Act (Obamacare). Even in GA! Here's the thing: Almost all policies say it is an exclusion "except where medically indicated" or some similar verbiage. Humana National POS in GA cover WLS. Go to Humana's website and contact their bariatric team by phone. They have a lists of doctors and hospitals affiliated with "Centers of Excellence."

Good luck!

Cleo

Actually you're both not exactly correct

Each state mandates what will be covered in their exchanges and whatvis mandatory that is above and beyond the ppaca legislation.

Ppaca(obamacare) does not mandate wls as a basic need

There are 32 states who require the coverage in their basic policies.

The other states some carriers offer riders, some don't.

You must thoroughly review and understand what you are purchasing.

http://www.pomcogroup.com/Default.aspx/ctl/EventDetail/id/a152612f-ac92-4aa8-88a2-d2def298c859

Check very carefully with the insurance companies directly for the plans you are considering. I purchased health insurance through the marketplace last year in Missouri. There are only two providers: Blue Cross and Coventry. Both specifically exclude bariatrics from all available policies. It varies by state.

Hello Everyone,

Please take my advice if you are in Georgia and plan to by insurance on the healthcare market place: Purchase Humana National POS. WLS will not be covered in the policy. It will be listed as an exclusion. Just call their bariatric team. They are wonderful! Unfortunately, it's not an issue of reading the policy and knowing what's covered and what's excluded. Insurance companies are waking up and realizing that the money the spend now they will save in the long run --mandate or no mandate.

I'm telling you what I know to be true from personal experience.

Best of luck!

Cleo

Why would they purchase it you said NOT covered??

By the way it's mandated by the state of Georgia to be covered. ????????????????????

Greetings Everyone,

The point I was trying to make is that although the policy (Humana National POS) says WLS is excluded "except where medically indicated," you'll be covered. Initially, I was told by Humana customer service reps that WLS was not covered. (They even sent me the portion of my policy outlining exclusions.) Then, I called Humana's bariatric team and they got me on board right away. They rock!

Obamacare is new and Georgia is fighting it every step of the way. Fortunately, some insurance companies are more Enlightened.

I've given my best advice for anyone considering WLS in GA and is looking for insurance on the healthcare marketplace.

Best of luck to you folks!

Cleo

I'm in arizona and purchasing aca plan thru bcbs... Covers wls while hubby s employer policy does not. Aca policy is the answer to my prayers