Let me preface this by saying that I'm not trying to engage in a political debate. I am, however, very interested to learn more about how today's healthcare bill (assuming it's passed in the Senate) will impact bariatric surgery coverage. Wasn't obesity considered a pre-existing condition before the affordable care act, and therefore usually denied? Any politicos/healthcare policy wonks out there?

I'm thinking that coverage remains the same for 2017 (since most policies are subject to annual contract renewal), but could those people researching/looking to have surgery in 2018 be affected? Thanks for any comments/prognostications!

Edited May 4, 20179 yr by bcl1628

At the Federal level? I don't think so because almost every red state (and I am just saying red state for a simple grouping not to engage in politics) didn't have obesity coverage as an essential coverage.

It will be up to the states under the new bill as I understand it. And then, if you have employer based coverage, you employer can choose to choose to meet the requirements of any state in the US regardless of whether they have employees there or do business there. So if State X decides that policies only need to have catastrophic coverage and no preventative coverage and that all people with a pre-existing condition go into high risk pools, you would be forced into a high risk pool that would likely not cover surgery.

As to whether MO is a pre-existing condition - if it is mentioned anywhere in any medical record you have ever had, you have a pre-existing condition.

This is part of the reason I moved to Canada (wife is Canadian), rather than move my wife to California with me. This whole pre-existing debate and situation is ridiculous. I despise the insurance industry as a whole.

Edited May 4, 20179 yr by PatientEleventyBillion

2 hours ago, Diana_in_Philly said:

As to whether MO is a pre-existing condition - if it is mentioned anywhere in any medical record you have ever had, you have a pre-existing condition.

Obesity is anything BMI 30 or higher, not just morbid obesity. That means millions of Americans 36 percent of the population have a pre-existing condition now.

https://www.cdc.gov/nchs/data/databriefs/db219.pdf

2 hours ago, OutsideMatchInside said:

Obesity is anything BMI 30 or higher, not just morbid obesity. That means millions of Americans 36 percent of the population have a pre-existing condition now.

https://www.cdc.gov/nchs/data/databriefs/db219.pdf

I argued that point with someone earlier! But I believe that if someone was not receiving healthcare for something specifically related to obesity in the past, it will not be considered a pre-existing condition. I even pushed my sister to start getting treatment for her high blood pressure; she's avoided talking to a doctor about it for years now but I feel she needs it on record that she's trying to treat her obesity so it can be considered pre-existing.

I also think the coverage is going to be more inconsistent among insurance providers than it has been in the past. whatever changes are made, I believe they wouldn't take effect until early 2019, but don't quote me on that.

Now, I am totally stressing about this.

Surgery won't be until August of this year.

I hope I don't get f*cked.

Sent from my SM-G900V using BariatricPal mobile app

23 minutes ago, linawina said:

I argued that point with someone earlier! But I believe that if someone was not receiving healthcare for something specifically related to obesity in the past, it will not be considered a pre-existing condition. I even pushed my sister to start getting treatment for her high blood pressure; she's avoided talking to a doctor about it for years now but I feel she needs it on record that she's trying to treat her obesity so it can be considered pre-existing.

I also think the coverage is going to be more inconsistent among insurance providers than it has been in the past. whatever changes are made, I believe they wouldn't take effect until early 2019, but don't quote me on that.

Pre-existing is anything in your record. So if they have recorded her weight at any point she has had a BMI over 30 that is a pre-existing condition. If they make you give or document your weight for insurance like they do for life insurance then they will know you are obese.

It doesn't matter if you have been treated for a pre-existing condition, just that you have it.

http://time.com/money/4763609/pre-existing-conditions-ahca/

Quote

• AIDS/HIV
• Alcohol or drug abuse with recent treatment
• Alzheimer’s/dementia
• Anorexia
• Arthritis
• Bulimia
• Cancer
• Cerebral palsy
• Congestive heart failure
• Coronary artery/heart disease, bypass surgery
• Crohn’s disease
• Diabetes
• Epilepsy
• Hemophilia
• Hepatitis
• Kidney disease, renal failure
• Lupus
• Mental disorders (including Anxiety, Bipolar Disorder, Depression, Obsessive Compulsive Disorder, Schizophrenia)
• Multiple sclerosis
• Muscular dystrophy
• Obesity
• Organ transplant
• Paraplegia
• Paralysis
• Parkinson’s disease
• Pending surgery or hospitalization
• Pneumocystic pneumonia
• Pregnancy or expectant parent (includes men)
• Sleep apnea
• Stroke
• Transsexualism

Quote

Here are some examples of those other conditions that experts have noted could hike premiums:

• Acid Reflux
• Acne
• Asthma
• C-Section
• Celiac Disease
• Heart burn
• High cholesterol
• Hysterectomy
• Kidney Stones
• Knee surgery
• Lyme Disease
• Migraines
• Narcolepsy
• Pacemaker
• Postpartum depression
• Seasonal Affective Disorder
• Seizures
• "Sexual deviation or disorder"
• Ulcers

http://www.nbcnews.com/health/health-care/what-are-pre-existing-conditions-what-would-gop-bill-do-n754836

Whatever changes there are, they won't be immediate. So it is important for people to get in the best health they can if and before these changes ever happen.

"Transsexualism" = pre-existing condition

LOL

Something you'd see on 4chan.

Trump just praised the Australian HC system as well.

Mixed messages.

In the end, as an American, I wouldn't care if it was universal or just gutting the insurance industry making people negotiate directly with their care providers, as long as the US HC system has a serious overhaul. And I don't count insurance industry mandates like Obamacare, they clearly make things worse.

Edited May 5, 20179 yr by PatientEleventyBillion

They are really just doing the most. I am really glad I had my surgery when I did and that I am basically healthy now. I have been toying with not getting down to a normal BMI because I don't feel it i necessary at this point, I just wanted to get my body fat to 30% or below but now I see normal BMI, is not going to be optional.

Will definitely impact Medicaid coverage of WLS.