Individual plans and coverage?

[Ronda68 2]

I am in tears, I found out that my insurance does not cover any form of weight loss. I don't understand how they will pay for a pap smear to prevent cervical cancer or mammogram for breast cancer but they won't cover Lapband or gastric bypass to help with cancers and numerous other things.

Does anyone know if there is an insurance company that offers health insurance with bariatic that you can buy as an individual plan? I am in search of dumping my current health insurance I get through work to get this done.

I started Weight Watchers and I am starving, it sucks!

Please help with any information on an individual plan.

Thanks

[elcee 3,343]

Most insurance companies won't pay as they believe that obesity is a self inflicted condition. They don't recognise it as a disease.

Mammograms and pap smears do not prevent cancer they are tests designed to detect changes that may lead to cancer. The costs of these tests are miniscule compared to the cost of a lapband.They also have evidence that these tests work whereas with a lapband it is only a tool - there is no guarantee that the recipient will lose weight.There is also a comparitively high risk that something may happen which could necessitate futher surgery and therefore further cost.

The bottom line is that insurance companies are companies that have to make a profit for their shareholders the same as any other business so they look at what is the most cost effective .

So although yes it does seem unfair they are looking after the needs of a large group of people.

I hope you find a solution soon. I agree WW and all the other diet programmes suck!( Apologies to WW). For some people they work in the short term but there are very few for whom they work in the long term. That is why the weight loss industry is such big business.

[ParrotheadCathy 0]

And remember one other thing. The exclusion of weight loss surgeries of any kind is actually more likely the election of your employer. Each employer negotiates with the insurance company about what is covered versus what isn't and they try to provide as much as they can for as little $$ as possible. Group insurance is expensive to provide, after all. Another employer with your same insurance company may have included WLS. It's an option that can be written in or out. You can't really compare Lap Band to a pap smear ($15,00 or so versus a lab test that costs maybe $25 is no comparison).

An individual policy would likely be expensive but perhaps you could find a second policy that would cover. Back in the days of the "straight 80% policies" I had a supplemental insurance policy that paid the difference on a hospital room between semi-private and private, the 20% on surgeons fees and anesthesiologists, etc.; paid me regardless of what my primary policy covered on mammograms, pap smears and some other testing. You'd have to talk to an independent insurance agent since if your employer offered any supplemental insurance you'd already know about it. Cost? Well, I can't even hazard what that might be for private pay....probably MUCH more than what you want or can pay comfortably.

[Ronda68 2]

Right, I understand the difference between the pap smear and the lapband tests and etc.... I'm just using that as an example as to why they can pay for that that will prevent cancer but they can't pay for the lapband that will prevet certain cancers and other things. I guess I'm just frusterated about it and am at a dead end. I did talk to my boss who's also a very good friend and she said our company is up for new insurance in February and she said WE will talk to them about either adding or giving an employee the option to add ot thiers if possible such as a rider. I am finding that there aren't any individual policies that cover WLS so I'm going to see what happens in February.

Thanks for your input!

[kagead 0]

I am self-employed and I have an individual PPO with BCBS of Illinois. Lap-Band IS covered on my plan, and I am attending my seminar tonight.

I am not sure what my out of pocket coverage will be (some people have had almost 100% coverage) but I do know that I am going to an in-network Dr. and hospital, so I am expecting no more than 20% plus my deductible. I do plan to ask about fill coverage specifically, as I am not sure if those are included or not.

Hope this helps,

kagead

[Ronda68 2]

I am self-employed and I have an individual PPO with BCBS of Illinois. Lap-Band® IS covered on my plan, and I am attending my seminar tonight.

I am not sure what my out of pocket coverage will be (some people have had almost 100% coverage) but I do know that I am going to an in-network Dr. and hospital, so I am expecting no more than 20% plus my deductible. I do plan to ask about fill coverage specifically, as I am not sure if those are included or not.

Hope this helps,

kagead

Good luck to you, I have looked online at the different BCBS of Kansas City and seen most plans do not cover the Lapband but I think I am going to contact them and see if maybe I am missing something. I pay $144.00 a month for my health insurance through my work. I would be willing to drop that and pay more for health insurance that covers the Lapband.

[kagead 0]

Good luck to you, I have looked online at the different BCBS of Kansas City and seen most plans do not cover the LAP-BAND® but I think I am going to contact them and see if maybe I am missing something. I pay $144.00 a month for my health insurance through my work. I would be willing to drop that and pay more for health insurance that covers the LAP-BAND®.

I would definitely make the calls. My plan does not explicitly say that bariatric surgery IS covered, but it is NOT a specified exclusion.

I went to the seminar last night and called BCBSIL again this morning to double check. At first the woman said that it looked like just Gastric Bypass was covered and when I questioned her about it she looked a bit more, put me on hold, came back and said that it appeared gastric banding is covered but was reliant upon the proper CPT code being submitted.

I am going to a BCBS Designated Bariatric Center, so I am going to rely on the team there to submit things in proper order.

Will keep you posted if I learn more-

kagead

Edited November 25, 2009 by kagead

[AZSunshine 0]

Hi there,

I work in the insurance industry, and I want to offer some advice....

DO NOT dump your current plan in an effort to obtain invidivual insurance. Doing so could royally screw you over.

I hate to sound like a party pooper, but it is close to impossible for an obese person (especially if you have co-morbidities) to get on an individual plan.

Employer group plans cannot legally discriminate, they are guaranteed issue for all employees.However, private individual plans are allowed to be more selective.... and because an obese person is viewed as higher risk, they generally opt to NOT provide coverage.

It's not fair... in fact, it completely sucks... (I've been trying to get individual insurance for over a year now, and have been told time and again that I'm "uninsurable") but these companies are businesses.... and they're going to do whatever it takes to NOT have to pay out big bucks.

I would definitely keep pestering your HR person about the plan change in February. Write letters to your company's boss.... and ask your coworkers to do the same.

Good luck!!!!!!!!