It's official! I just shot myself in the foot!!

I changed from my HMO plan into the PPO plan in december so I could pick the doctor I wanted.

Now I realize that my HMO plan would have covered the WLS but the PPO will not. I called and checked.....

The earliest that I'm allowed to change back to the HMO plan is january 1st 2010!!!

AAARrgggghh!!!

So with that being 10 months away, and the required 6 month preop prerequisites and then the approval time from the insurance company. That will probably put me at 1.5 years away.........

Does anyone know if I do the 6 month preop stuff before I change back to the HMO, will that be accepted by the insurance company?

I'm seriously considering going the self pay route. Even though I would have to take a loan.

But in this economy that might be a bad idea, who knows if I'll even have a job 6 months from now.

Ofcourse if I loose my job then I loose my chance to have my insurance pay and I loose my chance to take a loan to pay for the WLS.....

What would you do?

I didn't need to go through the six month pre-op diet as I had significant back-up from my previous doctors. My primary covered me and pushed through what was needed by my surgeon for insurance approval. Once all paper work was in I was approved in less than a week.

I had BCBS PPO Inland Empire.

By some rare coincidence, are you having a life changing event before your next open enrollment?  For example, getting married, getting divorced, moving, etc?  Sometimes these life changing events will allow for a plan change. 

With regard to the pre-op tests, generally speaking they are good for 6 months to a year, but double check with the surgeon you will ultimately choose.

Just grabbing at straws for you.

Hugs,
Barb

You can switch back to the HMO. You can do this at any time once every 5yrs. This is the law in CA. I know I did it. I hope this helps.

Hmmmmm life changing events..... Switching at any time, once every 5 years..........

Very very interesting!!!

Maybe I'm not FFL after all (FFL = Fat For Life)

Thanks guys!

 Did you get the criteria and read it for yourself? I wouldn't trust what the customer service rep at the 800 # tells you. You can get 10 different answers from 10 different reps, I know from personal experience. You need to get a copy and read it for yourself. Sometimes insurance will exclude bariatric surgery for obesity, but it's a totally different story for Morbid Obesity. If it's a blanket exclusion then you're probably out of luc****il open enrollment next year. Best of luck

we get the insurance manual at work, and i said that the HMO would cover WLS as long as your BMI is over 40 or 35 with comorbidities.

And the manual said that the PPO would not cover WLS under any cir****tances. Not even if you are morbidly obese ad has a doctors recommendation.

This was confirmed when I called. But if I can switch back to HMO then I should be good.

Thanks!

No you need to call back to the insurance company and ask to receive an evidence of coverage or ask them where it is online... Some medical groups will accept a 6 month program even before you join them.  I recommend that you make a monthly appointment with your dr to discuss your weight and any other health issues you have. If you have a great dr be open and tell them what you are doing.  Make sure that they document in their notes, the following:
current weight, your exercise, the fact that you are dieting, pound lost and ounds gained.  They also should be documenting your comorbidities.  I am not sure how much you weigh and what you bmi is but, you want to rmain in the area that will still qualify you next year.  Additonally if you know what medical group you are going to be with you will contact the member services department there to find out what their requirements are. Also, does your current dr take the HMO that you will be with when you change. You can also find a dr in your prospective medical group and see if they will let you go thru their process also.
Liz

Lizr, I love your response. Its great advice. I had thought about switching to my PPO thinking it woud be quicker but found out it would cost me a fortune (IF they actually did cover it) from my HMO and sooo glad I didnt switch. Definitely get weighed every month until you get approved.  Even if its just for an "ear infection."  Ask now for a nutition class or counseling, and no matter what dont let your BMI get lower than 40!  Start attending the support groups of the surgeon you will be using.   I too think you can switch from PPO to HMO and it probably will cost you less each month  if you pay premiums for the HMO.  Just do your homework and make sure the HMO you use will refer to the surgeon you want.  I asked at my local support group who had a WLS friendly primary care that refered to my surgeon. Then called that PCP found out what group they were in. Then I called the group coordinator (didnt tell them I wasnt a part of their HMO group yet) and just asked who their baratric surgeon was. Bingo! It was the surgeon I wanted. Called my insurance and switched!!!  My insurance only switches at the end of the month. The first of the month I made my appointment. Took a copy of the letter on my blog to the new PCP doctor on my first visit.   I had to play the switch doctors and groups game to get the surgeon I wanted, had to do the six month supervised diet per HMO group requirements but sooo worth is as they paid 100%
Good Luck!

I'm so sorry!  How frustrating!  I agree with everyone else, don't take this lying down!  Be a "sqeaky wheel", and don't give up until it's either covered or you're allowed to switch back.  I will never forget this piece of advice someone gave me once:  When the person you're talking to says they can't do anything to help you, very nicely say "I'm sorry that you are unable to help me, will you please transfer me to someone who can?"   Simple advice, but it has been very effective for me over the years!

Hang in there!  And the worst that could happen is that you do have to wait; you will  NOT be FFL!