Lost insurance... - ThinnerTimes

QueenB · 11-21-2004, 01:58 PM

Now I can't decide if these obsticles are hurdles to show my determination OR the Lords great big STOP sign. First off we carry our own insurance as business owners and it costs us $1,000 a month and it seems because it was our first time carrying for a group we were unaware that we had to offer employees insurance after a year of them working for us full time and got dropped by our carrier because we didn't enroll the one eligable employee who wasn't already enrolled. Usually we don't have employees for a year- they come and go at a really high turn over rate. This after I found out that my Dr hadn't resubmitted the referral request with the new information to my insurance before the 30 day period and had instead submitted an entire new referral. I should know by Monday if it was denied again.....this is taking alot longer than the original one

BUT I will no longer have THIS insurance (Sharp HMO carried by Pac Advantage) as of Dec 1st, it's a conspiracy! I just don't know which end is up at this point. I did manage to find us another plan (much better coverage and the copays drop from $30 to $5

) its a Sharp HMO offered by an independednt broker.....effective Dec 1 so we will never lapse in insurance but I don't know if I will still have to start over again........I am still trudging along. What are your thoughts about this?

Bigdave · 11-21-2004, 02:48 PM

I don't have any magic words but just keep moving ahead. All I can say is that in 3 months I've lost 103lbs and it is sure worth it!!!

Dave

watergirl · 11-22-2004, 06:46 AM

I do admire your determination. I know some people have had to wait for a year of what you are going through, so you're not alone in your battle. You're the only one that can say when enough is enough. Your co-morbidities will drive your decision. I wish you peace with this process.

bridgetgirl · 11-22-2004, 09:52 AM

I hate to be the bearer of possible bad news, but I hope to GOD that with getting new HMO insurance, that when your new carrier submits the request that they dont find your obesity a "pre-existing condition" and deny the surgery. If that happens chicken, hire a lawyer from obesity law.

I hope none of that occurs, but it is possible. Fingers crossed for you sugar pea, stay strong and keep plugging away.

Janet · 11-22-2004, 10:51 AM

It took me 18 months from start to finish to get my WLS. Between the original doctor dropping out of the HMO and losing insurance etc. All I can say is it is worth it. I even got an approval at one point the day AFTER my insurance coverage stopped. I had to start all over again.

Just realize that this is a life changing procedure and even though it is taking a long time, you will have the rest of your life to reek the benefits.

Hang tough.

Janet

suzshark · 11-22-2004, 02:16 PM

I just got hired by the company I have been temping with but I also had PAC Advantage Sharp HMO. I lost my COBRA because the owner bounced his COBRA payments. Then I got SHARP HEALTH PLAN individual coverage. Nothing really changed except the co-pay. Now, as of Dec 1, I will have Blue Cross of CA but STILL Sharp-Rees-Stealy group. Dr. Callery's office said that, as long as the group didn't change, your insurance would be ok. Also, with Blue Cross HMO (not PPO), they don't have ANY pre-exisiting conditions. The PPO did. Hope that helps. Sounds like you would be ok if you can stay with Sharp HMO group.

Good luck!

Barbarajo · 11-22-2004, 05:11 PM

I have blue cross of Ca and kelly told me that so far they have not had any problems with them at all. The ususally do approvals for surgery in 5-14 days.

QueenB · 11-22-2004, 10:04 PM

Hey guys thanks for all the info. As far as having a pre existing condition-I don't have to disclose because we aren't carrying an individual plan it's a group and we don't have to fill out any kind of history for a group plan. I talked to the medical group and the woman said I should be fine ....after getting word I was denied AGAIN for the same reason as before.......but to do the resubmittal after the insurance change (so after Dec 1st) Since we are only changing carriers, not actual plans, the med. group will be the same and it will just show our better benifits-blah, blah, blah..........I am ready to get on the Dr's office even more than I did last time, I am so dissappointed in them : ( Thanks again all....

Brittany

HapBird · 11-22-2004, 10:09 PM

Sorry you've had such a rough time of it, Brittany! Insurance companies sure do know how to jerk us around, don't they?

Somebody should sell insurance to protect us from insurance companies. But the premiums would be so high nobody could afford them!

bridgetgirl · 11-23-2004, 10:38 AM

Sounds like you have a handle on all this mess, way to go girlfriend!