Question:
IF I GET INSURANCE NOW HOW LONG SHOULD I WAIT TO FILE A CLAIM TO SEE IF I CAN GET SUR
I dont currently have insurance but if I get it NOW and let say they do cover this surgery (if that is possible) how long should I wait to check into it and try for the surgery? I know it wouldnt look right if I get the insurance on a Friday and submit a claim for this surgery a week later... — DBXX (posted on April 2, 2005)
April 2, 2005
Hi,
My insurance became active on July 1st & my doctor submitted my
pre-authorization request on the 3rd. It was approved. Once your coverage
becomes effective timeframe shouldn't matter. Good luck.
Judy
— j A.
April 2, 2005
But, do you think that is right? For me to buy insurance and before I even
pay the first premium to file a claim?? I know that is what insurance is
for but do you think they would deny it because of that reason alone?
— DBXX
April 2, 2005
Danielle, I don't think you have to worry about the insurance for the mere
fact, I don't believe any insurance company would pay for WLS for you.
Unless you are VERY SHORT you are not BIG enough for the surgery. Your BMI
has to be 40 or more unless you have many co-morbidities. Then your BMI has
to be no less then 35. According to your profile your BMI is ONLY
34................I think you should talk to a doctor FIRST before planning
on having this surgery............The WLS is for people to get HEALTHY, not
because they want to loose a couple of pounds.
— cindirella
April 2, 2005
Whether your insurance approves or disapproves solely because of your BMI
seems to vary from one insurance company to another. I know both seminars
I went to before surgery said it is EASIER to get approval with a BMI over
40. However, if you have DOCUMENTED co-morbidities(diabeties, sleep apnea,
high blood pressure, heart disease, etc), the insurance company may approve
based on that. The bottom line seems to be to have "physician
documented proof" your weight is negatively effecting your health.
Have read of some people that were able to get approvals with lower BMIs.
In answer to your question, I changed insurance in January and applied for
approval in March. Does it make it right or wrong to request approval so
quickly? I believe, since I'm going to be using their policy for years to
come, the savings they are experiencing on me becoming healthier BECAUSE of
the surgery MORE than makes up for the initial cost of it. Apparently, they
must have felt the same way since they approved it with no questions asked.
— Evangeline H.
April 3, 2005
Danelle, only you can answer the question of when it would be 'right' to
file for approval. However, coming from the insurance standpoint (I've
worked for them), it makes no difference whatsoever. Your effective date
isn't even looked at unless your request or claim is flagged as expired.
(which it wouldn't be)<br>Point of interest: My policy went into
effect March first, my initial appointment was scheduled for the third.
The only hang-up I see here is your own about how long one should have a
policy before you ask something of it. The answer is no time. You bought
something, you have the right to use it immediately. Best of luck to you!
— RebeccaP
April 3, 2005
ATTENTION, theres this pre existing problem:) Insurance will NOT let you
buy a policy and make a immediate claim, to discourage folks from just
geeting insurance when they are ill. This ONLY matters when you go from NO
insurance to insurance. She needs to find out what her pre existing
exclusion is:( Commonly 6 months and up:(
— bob-haller
April 3, 2005
Good point, Bob.<br><br>Danielle, are you buying an individual
policy or are you going for a group one? Some group policies do not have a
pre-existing clause (very few), but I have never seen an individual policy
that didn't. And to be honest, I've never seen one that covered WLS. (But
I know someone here has one, dunno who tho)<Br>If your policy has a
pre-x clause, do not seek anything that has to do with weight loss.
Nothing. Find out how far back they look for pre-x. (standard is 6mos)
What that means is that if you apply for some kind of WLS and they find out
that you have a diagnosis for anything weight related in the past 6 months,
then they will exclude anything related to that diagnosis for a full year.
(usually) Keep in mind that when you are morbidly obese, that diagnosis is
typically on every claim submitted regardless of the reason for seeking
health care.<br>I was lucky in my situation. I wanted surgery, sought
out employment where I knew it was covered and knew there was not a pre-x
clause.
— RebeccaP
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