Question:
Is anyone else finding that their employers are changed the coverage offered for 2005
I begain the process of getting WLS and found that my employer dropped the coverage for WLS as of 01/2005 from all the insurance options available to me, and I can no longer get the surgery scheduled before the end of the year. I want to know if this is happening to anyone else. — Susan R. (posted on December 1, 2004)
December 1, 2004
Yes, we have two insurance options at my job and one already had an
exclusion. The CIGNA option is changing effective 01/01/05 with an
exclusion for both WLS and plastic surgery to alter your skin due to having
had WLS. I am very lucky that I had my surgery this year in August. So no
you aren't the only one this is happening to.
— Greg D.
December 1, 2004
Yes, BCBS of Alabama had a cutoff date of Oct. 15, 04 according to an
article in The Decatur Daily, Decatur, AL newspaper. They have a freeze on
the surgery until they can decide what to do. One thing is to put a
patient wanting WLS on a supervised diet through their family/primary
physician.
— juju524
December 1, 2004
Susan,
Have you checked with all of the surgeons in your area to see if any (who
you feel are competent) could possibly squeeze you in because of your
insurance cutoff? I know that sometimes the office staff can be
sympathetic and do what they can to get you scheduled. I would spend a day
or two just making phone calls. If you know someone personally who had the
surgery and they can call their surgeons office, sometimes that can help.
When I was getting surgery, my sister decided she wanted to have surgery
also, so I was able to get her in on my consult appt. day. Of course we
ended up using another surgeon because that one left the state. But she was
able to miss like 3-4mths of waiting time that I had already done.
Just a suggestion. You could also try contacting the wls law center, I
think they would be able to advise you if you have a chance of fighting the
exclusion in case your deadline passes without approval. Maybe if you get
approval in december they may still have to cover it if it falls into
january, I'm not sure. But I definitely would go down fighting. Alot may be
accomplished in a month. Tell a surgeon (who you feel is competent that you
will take any cancellation dates, even last minute). But the key is to make
sure that you are comfortable with the surgeon and that you feel he/she is
qualified. Just because you dont have much time doesn't mean you should
risk your life just because they have a date open. I will keep you in my
prayers. If you want to talk feel free to email me.
Lisa postop lap/rny 10-23-03 340/179/??? -161lbs
— Lisa H.
December 2, 2004
If you already have an approval, ask your employer about continuation of
benefits coverage. Mine was excluded after I got a referral, but because I
was already in the process when the policies were changed the employer
approved for me to have it. If you check my profile, the info is in there.
Good luck to you! Shannon Open RNY 2/25/04 251/180/140
— M. Me
December 7, 2004
Yes, my company is changing their benefits to exclude WLS. They are
self-insured and were advised by the broker to drop the coverage due to the
"complications from the surgery". Horses Patoot! I am lucky
that I had my surgery almost 2 years ago, but I am very concerned about
some others who it might help. I have talked to our HR person, but don't
think they are going to change their mind. I love the company I work for,
but this is just wrong.
— Gail from NoVa
December 7, 2004
My company is not changing. However, I've heard that CIGNA is excluding
the surgery next year but I've been told we hear that same rumor every year
about this time. It's all up to the employer and what they purchase.
— J. Bee
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