Question:
My company is changing insurances, WIll grandfather clauses still be in effect for WLS?

I WAS TOLD THAT ANY MEDICAL PROBLEMS THAT WERE ON GOING WITH THE PREVIOUS INSURANCE COMPANY WILL BE GRANDFATHERED IN WITH THE NEW PLAN.INCLUDING SURGERY. DOES ANYONE KNOW IF THIS WOULD INCLUDE OBESITY SURGERY. I HAVE NOT BEEN APPROVED YET I AM STILL IN THE PROCESS(SINCE OCT.)SO I FEEL THE PROBLEM IS ON GOING. HAS ANYONE HAD A SIMILAR PROBLEM. IF SO CAN YOU TELL ME HOW IT TURNED OUT. IF ANYONE IS ASKING WHY I DID NOT HAVE THE BENIFITS REPRESENTATIVE GO MORE INTO DETAIL....IT'S BECAUSE HE WAS BEING VERY RUDE AND I DIDN'T ANT TO DEAL WITH HIM ANY LONGER.    — monique C. (posted on January 27, 2002)

January 27, 2002
I got my date and the same day we got word my D/H's insurance was switching. I was mortified. I was assured through human resourses that it would just roll over.I think there is a new law pertaining to this. I ended up having surgery before the switch took place, but, never the less, it should still roll over.Call back and hopefully you will get hold of a diff. rep. Best of luck to you.
   — Marie A.

January 27, 2002
My d/h's insurance changed the same month we were moving to a new city (he got transferred). I had (2 weeks prior) been approved (after an initial denial) and the surgeon in the new city was all set to make me a day. But the new insurance told the rep from the surgeon's office that I would have to go through the entire process _all_ over again :( Needless to say I've been waiting, again, since October 1, 2001. My d/h's HR rep even faxxed my entire file over to the insurance that same day in hopes the approval would go through quick. I'd love information about this law though that was mentioned. If someone could post it or email it to me I'd be forever grateful. My and my d/h are ready to get a lawyer to push the insurance into honoring the prior authoriazation from the old insurance.
   — Renee V.

January 27, 2002
The surgeon sent in my paperwork to the insurance company in October 2001 and waited and called November and December. It was a commercial insurance and we had to drop it at the end of December due to my husbands company. I picked up Aetna HMO insurance on January 1, 2002 and the surgeon's office said all they needed to do was change the date and address it to Aetna and send it in since all the test were complete. She did that 2 weeks after I signed up with the insurance and she called me at work on January 25, 2002 and said I was approved and my surgery date is 4/26/02. I didn't think it would work because I didn't have a referral since the last Insurance was commercial.
   — [Anonymous]

January 27, 2002
The only person who can really answer this for you is someone from your employer's human resources department. As you can see from the previous posters, two different people had two different experiences. Insurance plans are kind of like snowflakes. No two are alike. As for any laws pertaining to this, Colorado does have a portability law which prohibits pre-existing conditions clauses if you are merely transferring from one insurance plan to another. However, each state can have widely different laws on insurance and what's covered and what's not. The federal government can't make those kind of laws. They can regulate what Medicare covers and doesn't and that will apply to all states, but that's about as far as their authority goes.
   — garw

January 28, 2002
My company had it's insurance through Accordia. It switched to BC/BS effective 1/1/02. My surgeon had submitted my information on 9/6/01. Received approval on 12/2/01. My surgeon told me there was no way he could fit me into his surgical schedule by the time we switched over to BC/BS and, even better, he didn't take BC/BS insurance. So I was standing there with the approval in my hand and no surgeon. Made a few phone calls and found myself another surgeon who understood the situation and rearranged his surgical schedule to get me in before the change. The clause dealing with "ongoing medical treatments" in my case did NOT apply. The insurance rep. told me that the clause was geared more toward patients being treated for diabetes, cancer, etc. so that there would be no disruption in their treatment schedule. So if I had waited, I would have had to start all over with a new insurance company, new surgeon and a whole new set of headaches. Sorry I can't offer you better news. Best of luck.
   — Pam S.

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