State Employees/MUSC Options

I just came a benefits fair where I work and found out MUSC Options as of 2007 WILL NOT BE COVERING WLS!!! I thought I would let those know as soon as I did about it. The reason given was, in my opinion, lame. The surgery cost too much and there is a too high complication rate. Plus the rest of the State Health plan does not cover it, so why should they. Why doesn't the rest of the state cover the surgery, like MUSC Option does or now did. You know I did not mind paying the higher premium because I thought my insurance company cared about my health and wanted healthy clients. Guess they would much rather pay for all the co-morbs then shell out the one time money to keep us healthy. I know why am I fussing I had the surgery. I just think it is not far for any insurance company to not pay for WLS when the benefits far out way long term trouble. Plus I wanted to let those of you that have MUSC Options that this was happening as soon as possible. I with you luck. Julie

HOLY CRAP!!! I work at MUSC and have MUSC Options and I had no idea they were going to take away the benefit for WLS?!?!? I have to tell my coworker! She has a consult in October with Dr. Byrne for RNY. I was already banded a month ago, so thank God for small miracles. Thanks for the update.

Just one more comment (I'm still steaming here) MUSC sent a bill to MUSC Options for $15,000.00 for my Lap-band surgery. Guess how much reimbursement the hospital actually got???? $5000.00---weight loss surgery TOO expensive for the insurance to pay??!?!?!?! Don't believe it for a second!

I know I want to say they only paid about 1/3 of the cost of my surgery. Too expensive my foot! Tell your co-worker, I wish her luck. Julie

I am just as upset as you about the changes in musc options. But do you want to know what's weird? I has my surgery in Sept of 2005. They paid my hospital bill 100%, even sent me a refund of my copay. Do you think they changed it in 2006 because they were preparing to eliminate GBSin 2007? Now I am having to rush to get a plastic surgery consult because I am afraid that it will not be covered at all in 2007, then, state health plan here I come. Mary

The exclusions section does still say they will cover the plastic related to the weight loss, as long as you can prove it is medically necessary. Also you do get a 20% discount on plastics with the state health plan. But I am with you. State plan here I come if it is cheaper than what I am paying now. They are also raising the copay's for your PCP to $25/visit and specialist to $55. However, you will not longer need a referral to see a specialist. MUSC Options did pay anywhere near 100% they only paid their contracted amount. And I had to pay my $300 copay for a hospital stay. This whole thing makes feel so bad for those with MUSC Options and who chose it because the cover the surgery. I feel the rest of the State insurance needs to fall in line with them not the other way around. Julie

My plan is to sign up for the state health plan, then open a medical savings account. Contributing about 50 a paycheck will cover the copays, deductable and probably all medication. AND it's still cheaper than musc options. Its so sad, it was so great when I first had it. Mary

Yea I am looking at changing to a cheaper State Plan. I thought about the health saving account, however, you have to spend that money at the end of the year or you lost it. I wanted to do the health savings to start saving for when I get the plastics done but I do not want to lost the money if I do not spend it. And I agree, MUSC Options was great and I was a big advocate for them but they are really raising the rates of co-pays and medication so I am looking at other plans. It is sad that Health Insurance has gotten so expensive. Julie

Seems like a trend. in 2006 our Aetna plan started covering Bariatric Surgery. 50% co pay. Up to $10,000 maximum. I know I will have to pay a pot load of money, but I'm getting mine while the getting is good. I go in 10/5/06. I surely don't want to wait til next year. Our insurance picks come up in November. Only problem is we get to pick from Aetna PPO or Aetna POS. Big whoop. You'd think for a company of 96,000 employess world wide we'd get better choices than that!! Insurance -- 4 letter word Tink

You can say that again Tink! I wish you luck on your surgery. Not long now. I know you are getting excited. What I can not believe is insurance companies will pay for you to take all the medication and procedures for all the co-morbs but not to have a surgery that can get rid of most if not all of them. It just blows my mind. Again good luck on next Thursday and keep me posted on how you are doing. If you have any question let me know and I will be more than happy to help. Julie