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 got the Blue Shield PPO Ultimate which is the same as the platinum on the covered california exchange. I chose to purchase directly through blue shield because I had heard that the exchange plans have narrower networks

There's lots of great info here -- it does vary state by state as to whether WLS is mandated to be included in ACA policies. However, as with non-ACA policies, just because it's not mandated, some companies still cover it -- and some won't -- and some will specifically exclude it. But it's good info to know: http://www.bariatric-surgery-source.com/obamacare-weight-loss-surgery.html

Edited October 28, 201411 yr by della street

I got the Blue Shield PPO Ultimate which is the same as the platinum on the covered california exchange. I chose to purchase directly through blue shield because I had heard that the exchange plans have narrower networks

This is really true. I don't know specifically about bariatric surgeons, but my GP, the kids' pediatrician, the orthopedist, the neurologist all have signs up in their office saying they don't take the CA Exchange plans including Blue Cross. I always have to clarify WHICH Blue Cross I have when signing in

This is really true. I don't know specifically about bariatric surgeons, but my GP, the kids' pediatrician, the orthopedist, the neurologist all have signs up in their office saying they don't take the CA Exchange plans including Blue Cross. I always have to clarify WHICH Blue Cross I have when signing in

Well here's the thing too. By law they have offer the same plan at the same price off network so you can buy the plan you like directly from the company. That way your the customer #1. Though I do believe the reimbursements seem to be about the same but I believe it a lot of cases its the insurance companies NOT inviting the doctors to be on their panels rather that the MD's saying no.

Well here's the thing too. By law they have offer the same plan at the same price off network so you can buy the plan you like directly from the company. That way your the customer #1. Though I do believe the reimbursements seem to be about the same but I believe it a lot of cases its the insurance companies NOT inviting the doctors to be on their panels rather that the MD's saying no.

You may be right. All I know is it seems like in our area at least it's awfully hard to find a doctor if you have Covered California plans!

Hi there - I am self employed and purchased my insurance through covered California (Obamacare) in January. Elected the Northern California kaiser plan and was accepted into the Kaiser South San Francisco Bariatric program a month later and had my surgery in April. No hoops to jump through and the process was a breeze. Feel free to private message me if you want more info.

Edited October 29, 201411 yr by Bluesea71

Hello, what plan did you purchase? What was your co-pay for surgery?

I'm purchasing a BCBS plan in AZ -- silver plan Portfolio 3500. Max out of pocket is $3500. Will cost me premium-wise about $300-$350/month (net, after taking into account what hubby and I will save by me not being on his employer-policy which EXCLUDES bariatric surgery...)

Edited November 13, 201411 yr by della street

@@Cleopatra79 -- how long before you got the approval from humana???

@@bwaydiva I live in AZ, so I don't know if this would apply to you in CA or not, but I purchased BCBS of AZ on the Exchange (Obamacare) here in AZ last fall (hubby's work-policy specifically excluded WLS for years, ugh, so I purchased my own policy. Became effective 1-1-15; I had surgery 1-29-15. I did some of the pre-op NUT visits last December and some were paid by my hubby's policy that I was on at that time, even though they wouldn't pay for the surgery, go figure. But I wanted a head-start on the to-do list, so that when my policy became effective 1-1, I'd be as ready as poss. Info submitted shortly after 1-1; got approval within 2-3 days; got surgery scheduled for about 3 weeks after that.

Well here's the thing too. By law they have offer the same plan at the same price off network so you can buy the plan you like directly from the company. That way your the customer #1. Though I do believe the reimbursements seem to be about the same but I believe it a lot of cases its the insurance companies NOT inviting the doctors to be on their panels rather that the MD's saying no.

You may be right. All I know is it seems like in our area at least it's awfully hard to find a doctor if you have Covered California plans!

I know this is from a while back... in our case (I work for a doctor), this was not true. We got letters from the insurance companies that said things like, "are you willing to accept the new products we are offering that will pay you 70% of what we would normally pay you?"

A $50 office visit for $35? Our motto became "Just say no".