MNsure

belle2006beauty
on 11/23/14 3:17 pm, edited 11/25/14 5:08 am

Hello!

I am new to OH, and to the bariatric surgery process. I briefly looked into having the surgery with my current insurance. However i was informed that they have an exclusion and that no one had had luck getting an appeal through. So I put the idea on the back burner, as leaving my job was not an option. Sadly for me I will no longer have coverage through my job after the first of the year. So now I am looking to get insurance through the MNsure website. As I'm looking it appears that every plan has exclusions for weight loss surgery.

What I was to know is if anyone has gotten insurance though MNsure and if they had any luck getting bariatric surgery covered. I'm hoping that losing my insurance can be turned into a positive, rather than the hassle it has been so far. 

If anyone has any advice I would greatly appreciate it!

Jlynnr87
on 12/2/14 5:20 am - Elbow lake , MN

I have medical assistance through the state of minnesota and I just called them today and they said they do cover WLS you just have to meet their requirements. Not sure if this helps you at all. 

belle2006beauty
on 12/2/14 5:39 am

Thank you so much for your reply, and for calling! I was aware that MA would cover it, but I don't qualify for MA. Nor do I qualify for MinnesotaCare which also covers it. I have to buy my own plan through the MNSure website. From my research our state is not one that requires WLS to be covered so none of the available options say that they cover it. I'm guessing I'll have to try to appeal, and I'm hoping someone might have already gone through that process with the insurance available through the marketplace and could advise me on how it went. 

Alison B.
on 2/21/15 2:32 am
VSG on 05/28/15

I'm so sorry -- I just reread your posting and see that you are not eligible for MinnesotaCare. I did not end up purchasing coverage through the exchange as my employer provides health insurance. I hope you're able to find the information you need to begin an appeal!

Alison

belle2006beauty
on 2/21/15 4:05 am

Thanks for replying. As I had to have insurance I got the insurance and was informed that it's excluded (which I knew) and to not even try as they wont approve it. None of the clinics around my area have been willing to discuss doing an appeal with me. If my insurance says its excluded they won't let me set up an appointment. I've looked into changing jobs, but that's not as easy as it once was. 

I hate to say it, but it's making me really bitter. I know that if I quit working I'd qualify for assistance and I could have it covered. However I could never do that, and so I'm stuck without this tool that could potentially improve my life and my help. I'll keep trudging ahead with diet and exercise, but they haven't helped me be successful so far. 

Alison B.
on 2/21/15 2:27 am
VSG on 05/28/15

Hi there.

Before I was offered FT work with health insurance that does cover bariatric surgery (I'm in the process of being approved for surgery now), I too was planning to purchase insurance coverage through the exchange. I began researching MNsure and learned that Minnesota is among the 46 states that chose not to include bariatric surgery in its covered procedures (only California, Massachusetts, Michigan, New Mexico, and Washington, DC, consider it an essential benefit).

Do you know if you qualify for MinnesotaCare? I learned through a posting on this site that MinnesotaCare--HealthPartners does cover bariatric surgery if you meet certain conditions. As I was eligible for MinnesotaCare at the time, I contacted HealthPartners and was told that it is a covered procedure. I met the requirements (BMI, sleep apnea) and was planning to purchase HealthPartners coverage through MinnesotaCare.

I really hope that MinnesotaCare is an option for you. If you don't qualify, at this point in time bariatric surgery is not a covered procedure through MNsure's insurance providers.

I wish you the best as you investigate this possibility.

Alison

MrsReid
on 3/20/15 2:12 am

Instead of going through the exchange, look into buying a policy directly from Preferred One.  The price is a bit higher than NMsure, but they have individual policies and are very bariatric friendly.

    

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