Please respond, a short-term disability question

bomoni727
on 12/16/11 8:24 am - MN
Hello Fellow RNYers,

Just wondering if someone on here can shed some light on what has occurred with my insurance.  We recently had open enrollment on my job, so I decided this time around to apply for short-term disability to allow for things that come up.  At the time of my surgery I thought I had short-term disability but did not so during open enrollment wanted to make sure that I'm covered for anything that may come up in the future that I would need to have surgery for.  Well, to my surprise, I received a denial letter from insurance today saying the denial was based upon my weight loss surgery.  Apparently I am seen as some kind of risk.  Can someone with experience speak to this issue?  Thanks a lot.


Citizen Kim
on 12/16/11 8:38 am - Castle Rock, CO
Not sure how much things have changed (if at all) but WLS *was* seen as a Pre existing condition for a period of 5 years.

I'm sure insurance companies are still finding loopholes for this to be so!

Proud Feminist, Atheist, LGBT friend, and Democratic Socialist

MeganGish
on 12/16/11 8:42 am - Ashland, KY
 It was my understanding that you could not be denied for nsurance through your employer unless that only applies to health insurance?
sudemo09
on 12/16/11 8:50 am - Dover, NH
I think Megan is right.  I would call Monday and ask exactly what they denied.  Did they deny coverage for things to come in the future, or did they mis-interpret your application and think you were asking them to cover the time off for your surgery.

Even if the WLS is a pre-ex condition, and it will be, for a period of 2-5 yrs depending on the policy, other things can come up, like a broken leg, pneumonia, hit by a bus, etc.

I work for a major insurer and have never heard of coverage being denied, just individual claims based on how the policy was written.  And yes, I worked approving and denying STD claims......
      
Cicerogirl, The PhD
Version

on 12/16/11 4:34 pm, edited 12/17/11 4:34 am - OH
Rules for enrollment in STD, LTD, and employer sponsored life insurance programs are governed by different rules and laws than group health insurance rules. They cannot prevent you from adding health insurance at open enrollment based on medical condition, but they CAN require you to meet medical eligibility/insurability requirements in order to add the disability and life insurance programs.

Lora

10 years out; 190 pounds lost, 165 pound loss maintained

You don't drown by falling in the water. You drown by staying there.

hlacy
on 12/16/11 1:32 pm - Chandler, AZ
RNY on 08/17/11 with
I recall at my last employer, if you did not enroll in STD or LTD coverage upon being hired, you could be subject to a medical questionaire and possible denial due to pre-existing conditions and/or procedures. Perhaps this is what has happened to you, as it sounds like you did not enroll upon being hired?
"Keep a green tree in your heart and perhaps a singing bird will come"           

Cicerogirl, The PhD
Version

on 12/16/11 4:29 pm - OH
 Hlacy is correct.  Most of the time, if you do not enroll in STD or LTD (or even life insurance) options when you are hired, you are subject to approval/denial based on medical qualification if you try to enroll later.  It is prevent people from saving money by not enrolling in these programs and paying the premiums until something happens and your medical condition changes and you therefore are likely to actually USE them in the future.  It is, unfortunately, part of the way insurance companies balance things out between people who utilize the insurance more than "average"  and those who never use them.

It stinks, but you will probably not be eligible until the 3 or 5 years passes after your RNY (or you change jobs and sign up at the time of hire).

Lota

10 years out; 190 pounds lost, 165 pound loss maintained

You don't drown by falling in the water. You drown by staying there.

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