buying your own insurance - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

Megan_sf · 10-06-2009, 02:20 PM

i am 23 years old, i have been overweight my whole life. i have a terrible stomach that hangs down, it's very embarrassing and effects my self esteam, relationships, sex, riding my bike, wearing clothes...not to mention i'm just fat in general. my body has looked like this since 1st grade. i have always been a healthy eater...whole grains, fruits and veggies, lean proteins....but always heavy. i made a commitment last year to lose weight and sadly, in 11 months i have lost 15lbs. i need help.

i have not been insured in 4 years or so. I work as an artist full time and do not have an employer to insure me obviously. i am looking to buy my own insurance but don't know where to start. i can't afford paying $300/month to insure myself....but i want to be healthy and can pay up to $160/month. kaiser seems like a good option but reading the stories of what kaiser makes you go through scares me. i don't think i would be able to lose 10% of my body weight....and up to a year of waiting for surgery seems awful. i will do it if that's what it takes though. i also am worrying about qualifying. My BMI is 43...is that high enough? if i lose 10% of my body weight my BMI would be 38...no longer qualifying me. I'm confused how this works. I do not know my health problems are severe enough to qualify me...slightly higher blood pressure...and terrible depression/self esteam. does this qualify?

anyways...have any of you purchased your own insurance? can you provide insight to your expereince? please help. i am so sick of living in this body.

poet_kelly · 10-06-2009, 02:28 PM

Most insurance companies require a six month medically supervised diet. Not all, but most. So it would most likely be good while before you could actually have surgery.

Most go with your BMI at the time you start the process. So if start at a BMI of 43, even if you drop below 40 at the end of the six month diet, you would still qualify for surgery. Most insurance companies require a BMI of 40 or above, or 35 and above with comorbidities. High blood pressure, if you have to take meds for it, usually qualifies as a comorbidity. Depression and poor self-esteem does not. But that does vary from insurance company to company.

Some surgeons do require you to lose some weight before surgery. Mine did not, and I'm glad. But it's not uncommon.

All that said, I have not looked into buying my own insurance, so I can't give you much advice. I have heard that it is difficult to find individual policies that cover WLS. I think your best bet is to start calling insurance companies and asking them about what they offer to individuals. Good luck.

Kelly

suebry05 · 10-06-2009, 04:39 PM

sooo..do you have an employer or are you self employed? cause if you do have an employer perhaps you could buy into there insurance...even if they dont offer it to all- you would pay the bill...just a thought

also have you googled online for some insurance companies? and what if you self pay for the surgery? lapband would run you around 12K ish

jerseygrl684 · 10-06-2009, 04:48 PM

Quote:

Originally Posted by Megan_sf

i am 23 years old, i have been overweight my whole life. i have a terrible stomach that hangs down, it's very embarrassing and effects my self esteam, relationships, sex, riding my bike, wearing clothes...not to mention i'm just fat in general. my body has looked like this since 1st grade. i have always been a healthy eater...whole grains, fruits and veggies, lean proteins....but always heavy. i made a commitment last year to lose weight and sadly, in 11 months i have lost 15lbs. i need help.

i have not been insured in 4 years or so. I work as an artist full time and do not have an employer to insure me obviously. i am looking to buy my own insurance but don't know where to start. i can't afford paying $300/month to insure myself....but i want to be healthy and can pay up to $160/month. kaiser seems like a good option but reading the stories of what kaiser makes you go through scares me. i don't think i would be able to lose 10% of my body weight....and up to a year of waiting for surgery seems awful. i will do it if that's what it takes though. i also am worrying about qualifying. My BMI is 43...is that high enough? if i lose 10% of my body weight my BMI would be 38...no longer qualifying me. I'm confused how this works. I do not know my health problems are severe enough to qualify me...slightly higher blood pressure...and terrible depression/self esteam. does this qualify?

anyways...have any of you purchased your own insurance? can you provide insight to your expereince? please help. i am so sick of living in this body.

I pay $425/ month for my cobra. Not to mention food and everything else. Add in clothing i've had to buy. This isn't a cheap surgery. If you can't afford the cost per month for insurance, i suggest reconsidering your options here. It isn't cheap at all.

longing4thin · 10-06-2009, 04:49 PM

HI Megan,
you don't say where you live. Depending on the state there are different laws regarding individual insurance.

If you could get a job you could ask your employer what their plan covers and see if they will give you a position they would qualify you to be on that plan. If you don't otherwise qualify with number of hours worked the company could lose their policy if they allowed unqualified employees to buy in (for example they cover ees who work 40 hours per week but you work 35 hpw)

Hawaii has excellent individual insurance policies that are very affordable if you want an excuse to move to the tropics.

If you are in Washington Group Health coverage often covers the surgery, but I don't know about their individual policies.

Also the way the current laws are written you would probably have an 18 month waiting period because your obesity probably would be considered a pre-existing condition. (here is hoping health care reform gets passed).

In my past life I was an employee benefits person who designed medical plans so feel free to PM me if there are other questions I can answer.

suebry05 · 10-06-2009, 05:00 PM

as far as pre existing...not totally true in all cases... I changed my health coverage in September so it would cover my surgery ..I had surgery in December the same year- LS usually requires a history of obesity for a few years back- so its always gonna be pre- existing..you dont wake up one day 300 pounds

good luck on your hunt!!

and I am with the moving to Hawaii for good insurance!..as long as it comes with a towel boy!

odonnela · 10-07-2009, 04:29 AM

Quote:

Originally Posted by suebry05

as far as pre existing...not totally true in all cases... I changed my health coverage in September so it would cover my surgery ..I had surgery in December the same year- LS usually requires a history of obesity for a few years back- so its always gonna be pre- existing..you dont wake up one day 300 pounds

good luck on your hunt!!

and I am with the moving to Hawaii for good insurance!..as long as it comes with a towel boy!

But you HAD insurance - the pre-existing condition exclusion would not apply. Its generally only if you are going from having no insurance that it applies.

odonnela · 10-07-2009, 04:49 AM

Hi Megan,
I sell health insurance - and no this is not a sales pitch, I just happen to know a lot about it. I am in New Hampshire and insurance plans and laws differ by state - yes laws, there is a law in NH that if you are morbidly obese you CAN'T be denied. Ok so that being said there are a couple of options for you. #1 - IF you are your own business you can get group health insurance - you would be a Group of One, you do not need to have employees. There is no individual underwriting which means they can't deny you based on health conditions, and being age 23 would get you a "low" rate. I say "low" because while you would have a lower rate than someone who is say, 50, you may not consider the price affordable. In NH you can ONLY enroll/start a Group of One Oct 1 and April 1 - no other time. Again - don't forget that rules and such differ by state. And because you have not had insurance there could be a pre-existing condition limitation, meaning you may have to wait for certain things to be covered.
Ok next - #2 individual health insurance. They can underwrite ie: "discriminate" against you and its 100% legal. For example - I would be a decline because of my weight, because I have OCD, because I take Calcitriol for my thyroid. They have height & weight charts that they go by, if you are what they consider normal weight you can get "preferred" (lower) rates, if you are slightly overweight you could get "standard" (more expensive). There is also a myriad of other things that determine standard vs preferred vs being declined. I suspect you would be a decline due to your weight - at least in NH you would.
And then there is #3 - the high risk pool. Every state has one. If you are declined for individual health you can apply through the pool. The rates are high, in NH they rule is they charge NOT LESS THAN 150% of the standard rate. Its pretty much a last resort. But - weigh the cost of it, or any insurance, against the cost of dishing out of your pocket for any of these.
I want to caution you about "short term" or "temporary" health policies. They are dirt cheap, they have high deductibles, and they barely cover anything. They don't cover prevenative care, pre-existing conditions, ELECTIVE surgeries.... basically if you fell off your roof and broke your leg it would cover - thats why they are also called "Accident" policies. In NH they are 6 month policies and you can only renew 3 times for a total of 18 months. Once you renew it, anything from the last policy is then called a pre-existing condition and excluded. A lot of unscrupulous agents will try to push these because of the price - it can be as little as $50 a month - so be very careful.
So lastly, what you should do is open the phone book, look under Health insurance, and find and INDEPENDENT AGENT that sells health and give them a call. You want an independent agency because they represent more than one company. For example I have 4 companies I can choose from to place people with.
I hope this helps you or anyone else on here. I am giving this info as a friend not as a professional so keep ion mind that every states and every companies rules and benefits are different and some states may have options I don't even know about because I only do NH.
Good luck

lvl0rg4n · 10-07-2009, 08:47 AM

Good info, thanks for sharing.

Quote:

Originally Posted by odonnela

Hi Megan,
I sell health insurance - and no this is not a sales pitch, I just happen to know a lot about it. I am in New Hampshire and insurance plans and laws differ by state - yes laws, there is a law in NH that if you are morbidly obese you CAN'T be denied. Ok so that being said there are a couple of options for you. #1 - IF you are your own business you can get group health insurance - you would be a Group of One, you do not need to have employees. There is no individual underwriting which means they can't deny you based on health conditions, and being age 23 would get you a "low" rate. I say "low" because while you would have a lower rate than someone who is say, 50, you may not consider the price affordable. In NH you can ONLY enroll/start a Group of One Oct 1 and April 1 - no other time. Again - don't forget that rules and such differ by state. And because you have not had insurance there could be a pre-existing condition limitation, meaning you may have to wait for certain things to be covered.
Ok next - #2 individual health insurance. They can underwrite ie: "discriminate" against you and its 100% legal. For example - I would be a decline because of my weight, because I have OCD, because I take Calcitriol for my thyroid. They have height & weight charts that they go by, if you are what they consider normal weight you can get "preferred" (lower) rates, if you are slightly overweight you could get "standard" (more expensive). There is also a myriad of other things that determine standard vs preferred vs being declined. I suspect you would be a decline due to your weight - at least in NH you would.
And then there is #3 - the high risk pool. Every state has one. If you are declined for individual health you can apply through the pool. The rates are high, in NH they rule is they charge NOT LESS THAN 150% of the standard rate. Its pretty much a last resort. But - weigh the cost of it, or any insurance, against the cost of dishing out of your pocket for any of these.
I want to caution you about "short term" or "temporary" health policies. They are dirt cheap, they have high deductibles, and they barely cover anything. They don't cover prevenative care, pre-existing conditions, ELECTIVE surgeries.... basically if you fell off your roof and broke your leg it would cover - thats why they are also called "Accident" policies. In NH they are 6 month policies and you can only renew 3 times for a total of 18 months. Once you renew it, anything from the last policy is then called a pre-existing condition and excluded. A lot of unscrupulous agents will try to push these because of the price - it can be as little as $50 a month - so be very careful.
So lastly, what you should do is open the phone book, look under Health insurance, and find and INDEPENDENT AGENT that sells health and give them a call. You want an independent agency because they represent more than one company. For example I have 4 companies I can choose from to place people with.
I hope this helps you or anyone else on here. I am giving this info as a friend not as a professional so keep ion mind that every states and every companies rules and benefits are different and some states may have options I don't even know about because I only do NH.
Good luck