Question:
Have any self-employed been able to get the surgery approved by insurance co?
I am self-employed and as such am only eligible for certain insurance plans. Have HMO (HAP) and they absolutely will not cover any bariatric issues, called BC/BS only to get the same answer. Please help, I meet and exceed all the requirements for obesity surgery and cannot find an insurance company who will approve me for the surgery. Had heard that Aetna was very accomodating. Any info who would greatly appreciated! — [Anonymous] (posted on September 21, 2001)
September 21, 2001
Each plan is different, so although it may not be an exclusion on one Aetna
plan, it may be on another. I'm self employed, too, and had a revision (a
transection due to a staple line disruption) approved by Horizon BC/BS of
NJ with no problem, even with a BMI of "only" 35. They were not
even the company that approved my original surgery. Unfortunately, that
was Prudential who no longer writes health isurance. Because Prudential
had been bought out by Aetna, Aetna automatically sent me their info (this
was an HMO). All WLS was excluded, so I tossed them and went for BS/BS. I
don't know what State you're in, but I also hear Oxford is not too bad, but
you must check the exclusions for each policy. Also, don't be afraid to
cancel a policy within the first 30 days if you find out WLS is excluded.
The only problem then is you'll have to wait a few weeks for your refund
check while having to fork over another check to a new company. Good luck.
— Leslie F.
September 21, 2001
I too am self-employed, My husband and I purchased a Blue Cross Blue Shield
PPO Plan last November. I began my WLS journey in April of this year and
had my surgery on August 2nd. My policy stated " dietary counseling
for weight control, drugs etc.. were not covered except for necessary
surgical procedures..." It took about four weeks for BC/BS to approve
me but they paid all of it except 800.00. Not bad for only having this
insurance for only nine months. Contact me if you have any further
questions or concerns.
— Janet R.
December 18, 2001
My Husband and I are also self-employeed and I had a very difficult time
just finding individual insurance coverage because of my weight, so we
found a way to aquire group coverage (as it turns out 2 people make a
group). Luckily, In the state of Indiana Ins. Cos. are required by law to
cover WLS as part of group plans. So, if you are having trouble finding an
individual policy that will cover the surgery look into a group plan.
— Angela A.
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