Employers not paying for WLS - Page 2 - ThinnerTimes

Godsblessedme · 06-08-2008, 03:22 PM

Quote:

I don't understand why more employers arent covering it. With contractual agreements they will be paying FAR less in the long run.

i know its hard to grasp. but as stated in that article, people will have the surgery then soon after quit. I personally loved the concept that one of our hospitals i worked at had in place. Sure the insurance will cover the surgery AFTER a one year employement anniversary, well now as of today that is a TWO year anniversary which is insane. But i agree, i used to negotiate contracts and yeah employers couldnt pay that insane extra amount for that write on coverage of GBS so they get a cheaper rate to not have that benefit. Kinda like BCBS offeres a cheaper rate (individual plans) if you chose NOT to have maternity coverage on the policy. Same thing. I'm just glad i had the surgery and and it was paid for.

Nancy, yeah my surgery was around 35K and then because of some complications and an additional night stay and then 3 weeks later another 3 day stay my surgery costed pretty close to Frances' cost

princesse · 06-08-2008, 10:59 PM

Quote:

Originally Posted by frances

This is the part that I don't understand in all of this. MOST insurance companies, if not all, contract with providers to have them provide care for their members. Having said that, they contract with hospitals for differenc=t services at different rates. When I had my $78,000 surgery, the insurance company I had at the time was contracted with the hospital to pay a flat fee of $1500.00 per day and contracted with the physicians for a reduced rate as well. If memory serves, the total that my insurance company paid for hospital and physician fees was roughly $6000.00 - so it isn't costing the insurance companies as much as they are being billed.

I don't understand why more employers arent covering it. With contractual agreements they will be paying FAR less in the long run.

I don't get it.

ok, I am in shock!!! I think I've been away from america for too long. I just don't understand insurance companies, doctors & hospitals. & my dad was an administrator at a hospitla for 30 years.

Having said that, when I had Mags in '88, my ob/gyn double billed the insurance company...and they paid it. no wonder the prices are skyrocketing...

Quote:

Originally Posted by Godsblessedme

i know its hard to grasp. but as stated in that article, people will have the surgery then soon after quit. I personally loved the concept that one of our hospitals i worked at had in place. Sure the insurance will cover the surgery AFTER a one year employement anniversary, well now as of today that is a TWO year anniversary which is insane. But i agree, i used to negotiate contracts and yeah employers couldnt pay that insane extra amount for that write on coverage of GBS so they get a cheaper rate to not have that benefit. Kinda like BCBS offeres a cheaper rate (individual plans) if you chose NOT to have maternity coverage on the policy. Same thing. I'm just glad i had the surgery and and it was paid for.

Nancy, yeah my surgery was around 35K and then because of some complications and an additional night stay and then 3 weeks later another 3 day stay my surgery costed pretty close to Frances' cost

Hear, hear..If your company is willing to have a plan that includes these types of surgeries, I find no problem with them asking you to sign a contract for 1-2 years post-op. I mean of course, there can be extenuating circumstances that may cause you to have to stop the employment, but I think it's only fair...

I STILL think it's over priced in general. I'm SSSOOOOO grateful for socialized/national healthcare. It's actually one of my major reasons for staying here. I self paid but that's because I didn't want to wait the 2.5 years on the waiting list. Downside of socialized/national healthcare!!
Nancy

Sue0609 · 06-12-2008, 11:15 PM

When I started this whole process the hospital handed me a sheet about what I should do to see if it would be covered. I'd already checked the plan description and it said they "cover WLS if there is a diagnosis of morbid obesity". I have United Healthcare. The hopital insisted they are difficult but that they eventually approve it if the summary plan says it's covered (there may be hoops to jump through, like a 6 month diet, 5 years of weights, etc.). I was approved almost instantly because my former employer (I'm under COBRA) is generous when it comes to health insurance. The company is huge and is a real grind to work for, but the benefits are great. You need great health benefits at a company like that because a lot of people who work there end up getting sick.

It's all about the plan! DH's employer's plan is worse, that's why I stayed with COBRA after leaving the company I worked for. I'm about to start a new job search soon now that my surgery is done.