Switching insurance question

Hello everyone! I'm new here, but have learned so much reading everyone's posts. The before and after pictures are amazing!

My insurance plan through my job (Aetna) doesn't cover any bariatric surgery. There's an exclusion for it. Our 2 year old daughter and I are on this plan, and it's a pretty basic bare-bones plan. However, my husband's insurance through his job is Anthem BCBS, and is a much better plan. And RNY is a covered surgery as long as various conditions are met that I'm sure everyone knows all about!!

So, here's the deal. Husband's open enrollment period is in November, and I'm planning on him adding us then. I've spoken to his Anthem customer service several times, and they've told me there is NO pre-existing condition waiting period for my daughter and I, and that if I were added to the plan, the surgery is covered (after deductible) and I wouldn't have to wait for it. I went to the surgeon's informational session, and the insurance counselor told me that if I want to start the pre-requesite process now and pay for those appts out of pocket (or with my Aetna though they likely won't cover anything), I can. So I have my consult with the surgeon on Aug 10th, and then will start a 3 month pre-op diet with nutritionist meetings.

Has anyone switched insurances like this for surgery coverage? Did you hit any roadblocks along the way? Everything has been going so well, I'm terrified that something's going to go wrong. Will his insurance not accept me? Will they not approve the surgery after I've completed all the steps and paid to add us to his plan? I'm so worried but hopeful!

I think that you should switch to his in November when you are able to.  You could call the insurance and ask some questions, I would try not to say who you are if you can.  I have had a terrible time getting insurance now a year after surgery.  In fact, I just got insurance for my two kids and my husband and I am going without.  I am excluded on every policy so far that I have applied for due to having the surgery.  That is why I suggest you get on his and stay on his during and after.  What happened with mine is we could no longer have the insurance and so had to buy it elsewhere.  My husband's is terrible coverage, $12,000 deductible and very expensive per week, so we bought private insurance for them again.

If you change coverage during open enrollment and you are alreazdy covered under a group plan (which it sounds like you are), there is no issue with the new insurance company taking you and your daughter with no pre-existing condition limitations. 

You should talk to them about the situation, however, or talk to your surgeon's insurance coordinator, because BCBS is not obligated to accept any paperwork for any of the steps in the process if it is prior to your coverage with them and/or if it is with providers that are not part of their network.  They might, of course, but they also might not, and I would hate to see you have to repeat things in order to get approval!

Lora

I was in your boat. I was terrified of being excluded due to a pre-existing condition that I only did the free seminar at first. Once my insurance switched over, I made phone calls to them and set everything up. From what I read on these boards, lots of insurance companies are very particular. They may not honor the work you are planning to start soon.

A word of warning. I have Regence BCBS. My plan didn't cover bariatric surgery at all until 8/1/11 (I've had this insurance for over 20 years). Since I knew several months in advance that it was going to be covered, I tried to start all of the pre-reqs ahead of time - especially the required 6-month medically supervised diet. I got everything started, just to find out on 8/19/11 that they wouldn't count anything I did prior to 8/1, so I had to rush into my doctors office to officially start the six month diet... again! I finally had surgery on 5/15/12. Just be prepared!

Ahhh, I never thought of that! Thanks so much for the advice and warnings - you may have just saved me a lot of time and money. I'll talk about this to the insurance coordinator at the surgeon's office! That's awful that they can deny all the work you accomplished beforehand. I guess they look for any reason they can to deny the surgery, huh? Ridiculous.