Insurance Company?

All4MyLittleLoves
on 11/18/14 10:29 am

We're switching insurance companies and I'd love to hear if you're covered by a company you love who covered your surgery? I was denied earlier this year by UHC for not having any co-morbid conditions. Coverage for the surgery will have some impact on which insurer we go with.

Any suggestions? 

We live in Wisconsin, if that helps. 

(deactivated member)
on 11/18/14 10:58 am
VSG on 12/16/14

Well if you do not have any co morbid conditions then no other insurance company will cover your surgery. You have to have at least one comorbid unless your bmi is over 40 or greater.

All4MyLittleLoves
on 11/18/14 11:06 am

My BMI is over 40, otherwise I wouldn't be asking.

(deactivated member)
on 11/18/14 11:25 am
VSG on 12/16/14

If your insurance is provided through an employer then I would check with them. If you are privately paying you can research the healthcare.gov website to see what insurance plans in your area cover bariatric surgery. Most of those plans do not cover bariatric surgery but then again Wisconsin maybe a state that does. I'm saying this because I went through the same issue but in Pennsylvania.  Since "obamacare" the underwritten plans at one point covered bariatric surgery but now since those plans are being washed out these new plans are not covering bariatric surgery. They're not obligated to and only need to address the issue of obesity by providing nutrition classes or some alternative weight management program. 

(deactivated member)
on 11/18/14 11:32 am
VSG on 12/16/14

Also, make sure when calling the insurance companies about bariatric coverage to get a name. I was able to get approved for VSG because of a sales misrepresentation. When I was signing up for a plan, I was told bariatric surgery was covered as long as it was medically necessary. Low and behold it was an exclusion from my plan. If I was given the right information I would not have dropped my prior insurance. So  I filed a compliant and because I had all the sales reps info and of course the recordings of the convo from the company they made an exception for me. Just saying cover your basis. 

Brad Special
Snowflake

on 11/18/14 9:18 pm
VSG on 12/06/12

Many people ask questions and may not realize things such as that fact. If you had given that information in your initial post then they would not have needed to mention it.

Gwen M.
on 11/18/14 11:19 am
VSG on 03/13/14

Sadly it completely depends on the insurance company, the employer, and specific plans.  So the only way we could help is if we lived where you live and had the same employer :(  

As evidenced by my having UHC, no co-morbids, and no problems getting my surgery covered.  I'm sorry.  Your best bet is to call the numbers that you should have gotten in your open enrollment information and ask.

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)

Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)

All4MyLittleLoves
on 11/18/14 10:59 pm

That's the thing though, we aren't going through my husband's employer so we're just searching for a plan that will cover it. I suppose I should have said that in my first post.

Gwen M.
on 11/19/14 11:21 am
VSG on 03/13/14

Gotcha!  Good luck finding what you're looking for. 

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)

Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)

Jessica B.
on 11/18/14 12:51 pm

The insurance company doesn't necessarily matter if you're over bmi 40 or have co-morbidities. It is actually determined by the company you work for. I have Anthem who has denies a lot of people from what I've seen, but I've heard of a lot of people with my moms company that are approved. Good luck!

    
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