:)Can some one give some idea as to how long it took for their insurance to approve the Lap Band Surgery? (I meet all the criteria to have the surgery)

Thanks

I have BCBS of ND and found out I was approved in 4 - 5 days.

After-almost-a-year-of-qualifications-and-doctor-I-was-denied-through-Aetna.Now-my-insurance-has-been-changed-to=bc/bs-Please-forward-your-appeal-letter.-I-will-now-try-with-b/c/bs.

Thankyou

I have Anthem of NH for Matthew Thornton. My BMI was only 37 so I was worried. Got approval the NEXT day! Good Luck:clap2:

As to being declined by individual health insurance companies, I have some experience in this area. First as a person who applied with Blue Cross over the phone 5 years ago for coverage. I was told when I answered yes to the "do you have a CPAP device" question, that I was an automatic decline.

Later, when I was back on a group plan (my wife's), I began to write health insurance as a profession. I had to study and pass state certification exams in order to get a license. That license has to be renewed every two years and 30 hours of CEU's that meet the state's criteria are required for renewal. If I do not follow the state's laws on insurance I can of course lose my license.

I say the following not to confront any of the previous comments, but to give a better understanding of how health insurance really works. I can only speak to Texas health insurance and speak most authoritatively of the individual plans. Group insurance takes you no matter what your health situation is under their "open enrollment" provisions. So you can get in if you have a job that offers it or if you are a spouse of an employee. But you only get what the policy states it covers. Your imagination is always bigger than the policy, but the insurance company tends to follow the policy pretty closely and you have ZERO chance of getting something paid for that's not written into it. (KNOW YOUR POLICY!)

Getting in a group only means you are a member of the plan, with the features that the state law required and with the features the officers of the company decided they could afford. It may lack some things you assume it will have. State law controls almost every part of your insurance. And your state does not subsidize the insurance companies. No tax dollars go to Blue Cross. So the state allows Blue Cross to try and earn a profit, like other businesses (this is true in most states - Blue Cross in Texas is actually a non profit).

So, the group plans will take persons with health conditions that the individual plans won't. Remember that group insurance is offered as a "benefit", a part of your pay. If they want your skills, they won't think twice about adding another person to their group. In individual insurance, you provide your own "benefits".

The individual plans treat each individual application with the companies asking themselves if they can make a profit on the applicant. They know that some of the applicants will lose hundreds of thousands of dollars for the company, but they won't knowingly take those whose risk profiles are too high. They decline them. And they add ("rate up" or "rider") various health conditions (smoking, obesity, asthma,etc.) and decline many others (diabetics, cancer victims, morbid obesity, etc.)

Yes, N.J. and N.Y. are "guaranteed issue" states. In 32 other states, Texas being one of them, they are designated as "risk pool" states, where if you are turned down, you can apply to the state risk pool, and in most cases you will be accepted at a higher rate (about double the cost). How does N.J. deal with the unprofitability of clients with bad health entering their plans? By passing their true health costs on to others. If you think your health insurance costs are high now, try paying for someone else's coverage also.

It's certainly not a perfect systems, but someone has to pay for the coverage. Groups can add or pass on adding certain features (maternity, obesity surgery, etc.) based on their state's laws. Groups of a certain size in Texas (less than 25) can decline to carry maternity, and coverage such as obesity surgery is strictly an option, your company chooses off a list of upgrades over the basic plans as it shops for your plan each year. Each additional feature they add, causes some employees delight and more employees to tell the management the plan is once again just "too expensive." And some to drop coverage altogether.

So, back to an earlier posed question, "How can California deny individual insurance to a person who has had a CPAP device or obesity surgery?" Simple, your state law permits it. If you think that's wrong, lobby your state legislature. They make many changes each year to their health insurance laws. If it makes sense, nothing should be easier than to get your state to make the changes needed.

But don't forget, passing on the cost of your health issues in our system to someone else is not a given. Insurance seeks as an industry, to "share risk" so that many pay an affordable amount, and a few can have unaffordable treatments. The state sees it's part as working with those for whom the companies feel they cannot.

This brief explanation may not make your like the insurance industry any more than you already do, but that is the basis of why it does what it does. I believe we may see some federal intervention in the future, but I don't expect it to lay off all the current industry workers and replace them. Instead I see the government working with the the private sector more as it does with Medicare supplements now. But that's just my opinion.

Seen as a part of the American free enterprise system and without state and federal assistance, the insurance companies run a model that they can measure (using acutarial knowledge, etc.) and cost management (underwriting criteria) in a fashion that will help them pay back their stockholders, just like the companies most of us work for.

Learning what your choices are, what you policy says and staying as healthy as you can is our responsibility, until such time as the system is changed.