Question:
Has anyone bought private insurance to cover WLS?

Please let me know if you ave been successful in purchasing private insurance that will cover WLS.    — Stephanie S. (posted on December 14, 2000)

December 15, 2000
Hi! I purchased health insurance privately to cover WLS and will continue with my coverage after the surgery. I am self employed (1099 employee) and all that they asked for was my Schedule C on last years taxes and a copy of a business card and phone bills for 3 months. Guess they really wanted to see if I worked. I purchased Pacific Care POS. I am currently trying to go through the referral from my PCP so that the surgery will only cost me $10.00, but if that takes me too long, I will go straight to my surgeon and the most out of pocket for me is $2,500 max. Good insurance co., good coverage if you have the patience.
   — Joi G.

December 16, 2000
I too am self employed so I was looking into getting Pacific Care POS as well, however, I read the "exclusion and limitation" section of that policy and it had SPECIFIC EXCLUSIONS for WLS. I mean they had a WHOLE PARAGRAPH describing the exclusion. It was the worst exclusion for WLS I had seen! So, I continued to check out other companies and their plans. Finally, I came to the conclusion that when you are morbidly obese you can't qualify for standard insurance plans because of their height/weight guidelines in the underwritting ... unless, you have insurance with your employer or are able to qualify for a "small business plan." Well, like I said I'm self employed so I didn't have insurance through an employer. Nor could I qualify for a small business plan because you need to have at least 2 people in your business and mine consists of only ME. So, I found that my one and only last resort, besides paying cash, was to sign up for the Major Risk Medical Insurance Program (MRMIP) through the state of California. They HAVE to take you ... just like certain car insurance companies have to take you when you are a bad driver. However, there is now a waiting list of 9-12 months ... (it use to be 3.) You can choose from Blue Cross, Blue Shield, or Kaiser. I chose Blue Cross since it's a PPO and is cheaper than Blue Shield. But it's gunna cost me $244 a month. Now, to avoid waiting 9-12 months for insurance coverage, Blue Cross and only Blue Cross offers what's called a "interim" insurance called Level III at the rate of $361 a month that will kick in right away while you are on the waiting list for Major Risk. Both premiums are outragous to me especially the Level III interim. However, I've decided that hopfully paying $361 a month for this is better than paying cash for the entire surgery myself which is why I signed up for this and will be effective Jan. 1st, 01. Blue Cross is known tho to NOT pay good. My policy will pay 75% of the "negotiated fee rate" for "participating or preferred participating providers" and only 50% for "non-participating providers" at the "negotiated fee rate" So, I figure I WILL end up having to pay a chunk of my WLS, but how much exactly, I don't know yet. I'm in the process of finding that out now. The major risk plan AND the Level III interim have the same exact benefits and exclusions and limitations. The only good thing about this insurance is that I know it WILL cover the WLS because it says that the exclusion is: "treatment of obesity by medical, surgical or psychiatric means, EXCEPT FOR TREATMENT OF "MORBID OBESITY!" YEAAA! It took me a month to find out all of this, but I hope I'm on my way now. Anyway, this is MY story. I hope it can maybe help you and or others. Goodluck! :o)
   — [Anonymous]