I'm trying to remain calm... - WLS Journey Community Forums [Weight Loss Surgery Support]

Roni · 10-19-2009, 11:36 PM

I have group health insurance through work. I am going through their required steps to get my weight loss surgery approved. So far so good, but they require 6 months of supervised weightloss and exercise before I can get approval. No problem. Well, until now. My company was bought by a foreign company who is slashing expenses and benefits to the bone. We are due to get our new benefits packet next week and were told that all of the plans are changed. I have a feeling that either my current insurance company will be gone and I'll have to start over, or, and probably most likely, the procedure will now not be covered. UGH!!!!!!

Ok, like I said, I'm trying to remain calm. I don't know anything for sure yet, but I just have this feeling. Please everyone keep your fingers and toes crossed for me!

Debbie

MsJacquiiC · 10-27-2009, 04:27 PM

Damn! Don't know how I missed this thread. But bigger damn = insurance drama ARG! Debbie - I hope the changes their making to your insurance is decent and that you can still follow through and have your surgery!

Jacquii.

Roni · 10-27-2009, 04:59 PM

First the good news, although my employer has made major changes to the health insurance plan, they are staying with the same company that I currently have. I'm hoping that means the surgery will still be covered (though since the company is self insured..who knows). I won't be able to confirm that until January when the plan goes into effect.

Now for the bad news. This year I have a high deductible plan, but after the deductible, I'm pretty much covered at 100%. Next year, I have an even higher deductible, and must pay 20% of everything. I'm not sure I'll be able to afford it, but I need to sit down and figure things out.

For now, I'm continuing with the process as if I'm having the surgery. I'm trying to remain hopeful.

Debbie

MsJacquiiC · 10-27-2009, 05:44 PM

Absolutely remain hopeful! Who knows - regardless of the changes - they'll see that you've continued with the requirements as specified by the coverage you had before they implemented the changes, and still cover the surgery as they would have before the changes were implemented. I hope this is the case!

Jacquii.

BuCwiLd · 10-27-2009, 06:16 PM

aww, thats enough to drive me wild also. keeping my fingers crossed

Roni · 11-06-2009, 03:03 PM

I just received all the specifics for our new medical plans. They will no longer cover Bariatric surgeries or anything related to them. It doesn't matter that I'm already going through the pre-op program, if the surgery happens after 12/31, it will no longer be covered. The current plan I have will not cover the surgery until I've had 6 months worth of nutrition and exercise counseling which takes me into February of 2010. I'm so upset I can't even begin to express how upset I am.

In addition to them not covering the surgeries, the out of pocket expenses for next year are beyond what I can afford. One medication alone, which I pay $50 for 3 months will be $400 for 3 months next year. So, they won't cover the surgery that will get me off of the meds and improve my health, and they have raised the prices so that I can't afford the medications. Insulin...it's just a luxury anyway. I don't really need it! UGH!!!!!!

I'm not sure what I'm going to do at this point. For now, I'm going to go hide under the covers and hope this is all a bad dream.

Debbie

MsJacquiiC · 11-07-2009, 02:57 AM

Aw Girl! That sux = DAMN! I'm so upset for you!

I'm not too versed in matters of insurance - but I spoke to someone who is just the other day - I'll have her come take a look at this thread and see if there's anything she can advise.

But wow! I'm just MAD - how can the insurance company do that? It's like pulling the rug from out under you while you're standing on the damn rug ARG!

Jacquii.

Lynn P · 11-09-2009, 09:11 PM

Oh Debbie!

I know that given time a solution has to present itself. Lots of prayers for you...

Roni · 11-09-2009, 10:05 PM

Thanks everyone. I'm still pretty upset with this whole situation. I guess I just need to lose the weight the old fashion way.

Debbie

MsJacquiiC · 11-11-2009, 01:52 AM

Well Debbie - I asked Robin to take a look at this thread and see if there's anything she can recommend - I haven't seen her online in a few days though... I'm just thinking there HAS to be something that can be done - even if it requires you to find a new insurance company who does cover WLS...

Jacquii.