Hi there.
A newbie here.

I am just getting started and have my first info session next week, but have a question.

I am currently on my husbands insurance(Aetna). The plan does not have bariatric services.

Since open enrollment is coming up, I am going to switch to my employers plan (Highmark BCBS DE) because they do have it.

If I start seeing the Dr. and start that 6 month clock before I switch carriers, will they make me extend the 6 months?

TIA

Jen

7 minutes ago, Jenwill630 said:

Hi there.
A newbie here.

I am just getting started and have my first info session next week, but have a question.

I am currently on my husbands insurance(Aetna). The plan does not have bariatric services.

Since open enrollment is coming up, I am going to switch to my employers plan (Highmark BCBS DE) because they do have it.

If I start seeing the Dr. and start that 6 month clock before I switch carriers, will they make me extend the 6 months?

TIA

Jen

You will need to start over, potentially changing doctors too. I have GEHA, which works with AETNA and they certainly have bariatric services, your husbands plan might not have coverage, but AETNA does cover WLS.

Each insurance has different requirements, if you start on one insurance and move to another, more than likely the new insurance is going to have you start over and follow their requirements.

Maybe you do, maybe you don't - it's one those "it depends" things. Your new carrier may not even have a 6 month diet requirement, or it may be 3 months or something else. Check the website of your new company and look for their "policy bulletin" on WLS which will detail their specific requirements. The surgeon that you choose may or may not be in their network (check on the company's website, or ask the surgeon's insurance coordinator). Out of network usually just means that you pay more in co-pay to get the surgeon that you want, but some policies may restrict you to only those in their network.

Unless the company has some pre-approval requirement that you pass through before starting the process, there should be no harm in starting before the policy is in force, as the requirement is usually just a documentation exercise, but worst case is that you may have to continue the effort an extra couple of months.

Thank you guys.

I switched and did not have to start over. It actually helped me be more ready. The cost savings was more than worth it. I started in October and had my surgery in April. My surgeon submitted paperwork from both my previous doctor and my new doctor to show the 6 months of dieting. Good luck to you.

So I thought I would put the resolution to this on here in case others are on the same boat.

My surgeon's coordinator looked into this for me. Because of where I live (Western Pennsylvania) and the constant battle with health insurance (Highmark and UPMC) people jump back and forth all the time. My surgeon is on both the aetna plan I am currently on and the Highmark plan I am moving to. So I am good to go.

The coordinator also told me that Highmark made a recent change to their medical policy regarding wait time until surgery. They got rid of the requirement on the plan that i am moving to.

So I have my pysch consult and dietitian appointments in a few weeks, labs to go do, a couple of more weigh ins with my PCP, and then another appt set up with my surgeon in Mid-December. On January 2nd, they will submit to my new insurance to get approval and if all goes well, I will have my surgery before the end of January!