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Purchasing New Health Insurance

Guest kxbght

By Guest kxbght, in LAP-BAND Surgery Forums

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Candle    11

Candle
Posted

I have Anthem BC/BS there's an exclusion on my policy too.

I am canceling and taking out an individual plan with GHI (I think they are only a NY company) They cover the band and as long a there's no gap in coverage I'm told I don't have to worry about the weight being a pre-exsisting condition.

I'm not completely convinced this is going to be as easy as it sounds but we'll see in a few months when I finish the doctor supervised 6 month diet and we submit to the insurance company ...

*fingers crossed*

Between co-pays, the shrink and tests not covered by insurance, I'm out about $750 out of pocket. I'm going to freak if GHI doesn't cover it. Plus I'll be stuck with their crappy plan until open-enrollment in Jan for my regular BC/BS policy.

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FocusOnMBM    0

FocusOnMBM
Posted

Yeah I'm with you as far as being stuck on my new (not crappy, but more expensive!) plan until open enrollment as well. :D

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Candle    11

Candle
Posted

Luckily, mine is the same price, so my employer agreed to switch the plan for me but the coverage isn't as good as what I have now. They call it a hospitalization plan. Meaning they cover testing - hospitalization - surgery - etc but not the fee for office visits.

I'm trying to get all the pre-op tests done while I still have BC/BS. LOL!

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FocusOnMBM    0

FocusOnMBM
Posted

That's just it: people who are eligible for group insurance are NOT eligible for individual coverage in NJ--they don't meet the criteria for insurance. Focus, you were misinformed. I just looked it up and one of the MAIN criteria for being eligible for individual health insurance (in the state of NJ, people, I'm only talking about NJ) is NOT being eligible for group insurance. Sure, you may have slipped through the cracks, but when you applied for individual you should have been asked if you are eligible for group.

If you were asked the question about group eligibility, you should have answered yes, and you should have not been permitted to proceed with your individual application. If your individual carrier decides to investigate at some point you might be kicked off the individual plan and have all your claims reversed. Under certain circumstances if you already have an individual plan you might be able to keep it if you join a group policy, but the reverse is never true. Individual coverage is NOT supposed to replace or supplement group coverage under any circumstances.

Things like this happen all the time and you may very well not get caught. I'm just letting you know what the laws are in the state of NJ. Is your company a NJ-based company? Are you a NJ resident? If both of those are true, then what your insurance agent told you is not. (Is the agent licensed in NJ?) What individual policy did you buy that didn't ask if you're eligible for group?

The card says Liberty Plan Access by Oxford. It's a PPO.

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Alexandra    55

Alexandra
Posted

The card says Liberty Plan Access by Oxford. It's a PPO.

The information I quoted above is from the enrollment form instructions for that plan. I think you would be wise to reexamine your situation. The last thing you want is to get stuck holding the bag for all your medical expenses.

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Alexandra    55

Alexandra
Posted

Good decision! :)

Now, on to what's really important: where are you being banded? Who's your doctor?

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Go To Topic Listing LAP-BAND Surgery Forums

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
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    • KimBaxleyWilson

      KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
      · 0 replies
      1. This update has no replies.
    • bellaamey

      bellaamey

      https://alluniqueguide.com/java-burn-coffee-reviews/
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