Insurance and work crap... - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

samtherockstar85 · 05-19-2009, 10:02 PM

It's open enrollment period at work and I'm upset because Rite Aid can't help me and the insurance company I'm interested in can't help me either.

I currently have a HAP HMO and am looking into Highmark Blue Shield PPO. Which I thought was just out of PA and I live in Michigan...but they tell me I can get it here. Anyway, I want to know if Highmark will cover it because HAP says I have to have a 12 month diet, which I have started.

I started out with the benefits department. I told them what I wanted done and they weren't able to find any info on it and said I would have to call the insurance company.

I call Highmark and they say that there's no way of telling me because they don't know if the employer has excluded it or not and that I'll have to speak with someone in benefits. So they direct me to the corporate office and give me an extension number.

I call corporate and once again "There's no way of telling you'll have to call the insurance company."

I call the benefits department again...and on hold for a long time and once AGAIN told to call the insurance...so I do one last time.FINALLY I get somewhere, the guy says if I can get a group number they can tell me if it's covered. He also told me all of the requirements for the surgery. A 6 month diet sounds much better than 12 and I meet all the other criteria and he says people get it alot. So it definitely is covered if the employer has elected for it.

Called the benefits department again and by this time I'm pissed. The rep didn't even know what I was talking about because he kept asking me what they meant by group number. At one point he even asked me if it was a phone number I was looking for.. He also kept placing me on hold until he finally told me they can't give me a group number because THEY DON'T HAVE IT and even if they did they would not be able to give it out...What? The guy did suggest I call corporate again and see if there's some way to get the group number if not call HR and try to figure it out.

I call corporate again...guess what? Closed. Awesome.

I spent over an hour on the phone during work hours and hardly found out anything. Between school (full time) and work (full time) I have no time to call during the benefits work hours 8am-7pm and am forced to call while at work. Boss wasn't too happy about that but what can I do? Now I have to spend even more time at work tomorrow trying to get a group number out of these people. Which, I'm not too confident about. I will go to HR if necessary but I'm trying to avoid that.

Has anybody else had to jump through hoops like this JUST to see if it's even covered? I don't want to make a mistake in choosing my insurance. The benefits of this plan and the one I currently have really are about the same but if it means no surgery I don't want to switch. Even if I have to wait a year that's better than not getting it at all.

And I'm studying medical billing? Am I crazy? =p

deputymauldin · 05-20-2009, 01:16 AM

I am so sorry you are having such a difficult time. Can you call HR and ask if they exclude WLS in general? That is something they should be able to answer without a group number. I wish you luck. Hope to hear good news tomorrow. Also if you chose the PPO do they still require the 6 month? My HMO did but when I went through the PPO I didn't need to.
Dena

Jeanie · 05-20-2009, 09:40 AM

Do you have an insurance card or does someone in your office have one of the carrier that you are looking for the group #? If yes get it off of the card, if not call HR they should be able to give you the group # with no problems. Good luck!

samtherockstar85 · 05-20-2009, 08:56 PM

I did call HR again and got the group number. IT'S COVERED! =) 6 month diet and coverage starts on July 1st. So throughout all of June I will be doing some serious research. I would love to go to the hospital and do my diet with them. I will have had 3 months in so far with my current dietician but who knows if that will count.