Question:
Just changed jobs...with a new school district. Which insurance??

I have some choices for insurance. Blue Shield Net Value (HMO), Pers Select (PPO), Pers Choice (PPO). Any suggestions??? Also are there any exclusion that are known with the insurance company?    — sweetcheeks194 (posted on August 11, 2008)

August 11, 2008
Nicole, consult your employer possibly even calling the insurance companies to see if they have exclusions for wt. loss surgery. Every insurance is different. I had Healthlink (with wls exclusion) I changed jobs and got Healthlink again and it paid for the surgery at 100%. Good Luck
   — mary_rn

August 11, 2008
Before making your choice, I would ask the HR Manager, who has to keep your conversations with him or her confidential between the two of you to check and see what coverage there is for a Bariatric proceedure and after what waiting period. That HR Manager is there to serve you. I am CEO of a medium size company and the one person other than our corporate attorneies we know that has to keep things regarding employees conversation confidential is the HR Manager. They can obtain the facts for you and let you put your mind at easy rather than depending on what someone here might tell you, which might be 100% correct at their company, but the rules for the same insurance company with the same policy names are different based on the decision of the company when selecting the plan and establishing the rates the company and the employee will pay. In our company there is no bariatric coverage, and I had to pay for my own RNY WLS. I want to see it changed for my employees, but we are currently locked into the policy the way it is with our insurance company, United Health Care.
   — William (Bill) wmil

August 11, 2008
I have blue shield ppo and so far the process has been simple. Only 2 things were required 1. Medical neccesity 2. psych eval. My impression is with an HMO you may need to jump thru a few more hoops. Example of seeing a dietician for 6 months, loosing weight prior to surgery etc. Good luck
   — urbrat2

August 12, 2008
We have the Choice I think and I had no problems with getting approval. Be aware though that each company can have their own exclusions and all so you would still need to check it out. If you are going to have the surgery make sure you also set up a pretax medical flex account to cover all the out of pocket stuff like copays and all. We did that and it has made the process so much easier because everything we have had to pay for we have just paid using that account and we should not have any surprises.
   — ibeanniebe

August 12, 2008
Unless some of your co-workers read this board, this isn't the place where you are going to find the info you need. The Blue Shield HMO offered by school district A is different from the Blue Shield HMO offered by school district B is different from the Blue Shield HMO offered by the local university. I would suggest making an appointment with someone in HR and see if you can get documentation for each plan that lays out what is and isn't covered. It would also be a good idea to make a list of and call all of the doctors you have seen in the past year to make sure they accept the insurance (because the lists maintained by insurance companies are not always correct). Good luck!
   — mrsidknee

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