Help! Shopping for Health Insurance

Hello all.. This is my situation..

I live in Pennsylvania. Last year i started the process of all exams

medical visits for the process of going thru and getting Gastric Bypass.

I had keystoneHealth plan East when my Doctor submitted it was denied two times.

So i canceled the insurance. Now the past months i have been trying to look for new Health insurance

that won't give me a hard time.

If anyone has any info i would grately appreciate it.

What else can i do????? help

Kristina, here is a thread from a few years ago, that might help you.

http://www.obesityhelp.com/forums/insurance/3876072/Keystone -Health-Plan-East-PA

Did you ever find out why they denied your two submissions from your other Dr? And, was it your Bariatric Surgeon who submitted or your PCP? If it was your PCP, that may be the reason. You always want your Bariatric Surgeon to request prior authorization for the procedure he/she will perform. The insurance carrier cannot make an informed decision on your care until the Bariatric Surgeon submit their findings on what he suggest the best plan of treatment should be.

If this was your Bariatric Surgeon, try to get the specific reason for denial. There may be a lack of information being submitted or an appeal may need to be completed. Even though you have cancelled the policy, do try to find out this info, as it will help you in determining what route to take with your new carrier.

I hope this information is helpful!

Nik

Thanks Nik for the reply.

My surgeon was the one to submit, and the reason they gave was that it was not covered by the plan i had at the time, my Doctor appealed and it was denied once again.

I'm not backing down! Thanks again.

most BCBS plans seem to cover the procedure and fairly easy without a waiting period.

my BCBS doesn't because DH employer didn't purchase coverage for it. Most plans cover it if the coverage has been purchased.

My insurance is not through an employer. I had to purchase my own. The insurance is 16 a month 500 deductible 700 max out of pocket. Purchasing your own can be very helpful

Can you please give me the name of the insurance company??? My company policy does not cover it, so i need to purchase an additional policy that does. thanks

I have the BCBS blue value plan

I have to purchase my own I'm self employed. I had Keyston health plan east was expenssive but got denied two times so now im stuck looking for Health insurance again.

Kristina, good for you! Don't back down. I had a lengthy period of trying to have surgery, so I know the frustration.

Are you looking for a private plan to purchase on your own? In my experience there are few that cover wls. However, I would suggest you start by asking specifically if bariatric surgery or weight loss surgery is a covered procedure. You can ask the insurance broker and if there is a rider or exclusion, they have to disclose this to you. You will probably pay more for a plan that covers it, but it will be worth it! Just a heads up, any plans that are Obamacare, DO NOT COVER BARIATRIC SURGERY! So, clarify that info with the broker too.

Wishing you success in your search! :)