Question:
My insurance changes July 1, the new one doesn't cover WLS, What do I do?
My insurance changes July 1 from Aetna to Regence Blue Cross. Regence Blue Cross has never paid for WLS that I know of. We just purchased a home so not enough equity to cover the cost. All my pre-ops were completed the end of May. Just waiting for the Dr's Office to submit to insurance for approval. What if WLS is out for me? Is there any hope? Thanks for your reply. — Cari F. (posted on June 14, 2002)
June 14, 2002
The only option that I can think of for you would be to request
"Transition of Care" paperwork from the new carrier. This would
allow you to continue any treatment already started w/your new insurance
carrier. I would also suggest having your doctor send for approval to
Aetna ASAP. This way, you'll definately have a better chance of qualifying
for Transition of Care. You can also notify your new carrier that
treatment was previously approved (if it is by the time your change
carriers), make sure you check you new plans exclusions to find out if WLS
is covered. I hope this helps!
— Rosario T.
June 14, 2002
I may be completely wrong here, but I am pretty sure that someone here in
my company had the same type question (different surgery) and was told as
long as there wasn't a laspe of 60 some odd days, then they are supposed to
view it as the original insurance company had. This seems especially good
since you have alreayd had all of your pre-op things done. I know you have
to give the new company your "certificate of coverage" which the
old company is supposed to give you once your insurance with them is
terminated. I hope this helps. Best of luck!
— karmiausnic
June 14, 2002
I had something similar happen to me at the end of last year. I had
already been approved when it happened though - my problem was getting the
surgery done before my insurance switched. I accomplished this by
switching surgeons. The transition of care some folks mentioned did not
apply in my case - my new insurance (BC/BS-PPO) only accepted a transition
if it was for something like chemotherapy or dialysis. My situation was
considered pre-op testing completed for surgery -- the tests did not have
to be repeated but I would have had to submit to the approval process all
over again. Because your surgeon has not even submitted for approval from
your company, you may be in for an uphill battle. I'm not sure but I don't
think you can pick up COBRA coverage if other insurance coverage is
available to you. Have you called the new insurance company and explained
the situation to them? Have you spoken to your company's Human Resources
Department? Would your surgeon be willing to get off the stick and get
those forms in to Aetna on Monday and then, hopefully, get you scheduled
IMMEDIATELY upon their approval (I think Aetna is usually pretty quick with
their responses.)? Don't give up -- I didn't and I'm SO glad I didn't. I
ended up being discharged from the hospital on 1/1/02 - technically under
my new insurance, but my old insurance picked it up without a fight and
have paid the hospital's claim. I wish you luck!
— Pam S.
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