insurance cobra problem - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

addisonsgran · 01-08-2009, 01:38 PM

I have bcbs of Il. thru Cobra. Their packet looks like I would meet requirements if I do the 6 mo dr. thing, etc. I could have the surgery in the spring-my cobra runs out in August which is okay but ins. company is telling me I may not be insurable or have lots of riders on my new individual policy(which doesnnn't cover lap-band at all) I have an excellent health record--no surgeries or hosp. except to have 2 kids.I now have high blood pressure and high cholesterol bmi i think is 34. Anyone have any advice-should I go thru with the surgery and take a chance on not getting insured after that?

sar4boy · 01-08-2009, 02:19 PM

I too have bcbs of Il and am on the cobra. I did the whole 6 month thing, which they do not pay any of the dietician visits during this 6 month period but they did pay for the psych eval and the upper GI.

My problem is that my DH had the ins and the company closed in June but they paid the cobra for 6 months. We can pay for it for the next 12 but it is $1300 per month and my insurance where I work is obviously cheaper per month but will not cover the surgery.

So I started appointments in June, knowing that I would have to have it done by the end of Dec. Well, I had some ulcers that needed attention so that pushed back surgery. In the meantime the dr sent the paperwork in and it was denied because of wrong codes... my dr sent in new codes and they were approved.

So now that my story has gotten very long... I am going to have to pay one month or maybe two of the COBRA for bcbs and then I will be going on my employers insurance and there should be no pre existing clause since I am not letting there be a gap in coverage. (at least that is what HR is telling me)

I guess I would say that if you will not have a gap in coverage you should be fine.

Vikkator · 01-08-2009, 02:42 PM

I think what you're asking is whether or not you'd be insurable through a new insurance company, is that correct? I would think that if you had the surgery, you'd be healthier because of it. In which case, I don't see why you'd need riders.

Also, you say your BMI is 34. I realize you have a couple of co-morbids, but 34 is a lot lower than what the guidelines normally are (usually 35+ with comorbids or 40+ without ).

Sometimes you might talk to someone at the insurance company who doesn't know all the facts. I'd call again and see what they have to say.

Julia_N · 01-08-2009, 03:51 PM

When I was on COBRA, I was told that if you had continuous coverage from your previous insurance that the new insurange company couldn't deny preexisting conditions. However, that was going from group policy to a new group policy, so maybe that doesn't apply to you.

Good luck!

addisonsgran · 01-08-2009, 03:56 PM

Quote:

Originally Posted by sar4boy

I too have bcbs of Il and am on the cobra. I did the whole 6 month thing, which they do not pay any of the dietician visits during this 6 month period but they did pay for the psych eval and the upper GI.

My problem is that my DH had the ins and the company closed in June but they paid the cobra for 6 months. We can pay for it for the next 12 but it is $1300 per month and my insurance where I work is obviously cheaper per month but will not cover the surgery.

So I started appointments in June, knowing that I would have to have it done by the end of Dec. Well, I had some ulcers that needed attention so that pushed back surgery. In the meantime the dr sent the paperwork in and it was denied because of wrong codes... my dr sent in new codes and they were approved.

So now that my story has gotten very long... I am going to have to pay one month or maybe two of the COBRA for bcbs and then I will be going on my employers insurance and there should be no pre existing clause since I am not letting there be a gap in coverage. (at least that is what HR is telling me)

I guess I would say that if you will not have a gap in coverage you should be fine.

I am new to this site-might do something wrong. I really appreciate your reply-sounds like we have something in common. are you saying that I could get locked into my new insurance(that won't pay lap-band) while still on Cobra.? It is at this point a bcbs individual policy. They suggested I stay on cobra til after surgery and take my chancesbut they had just turned someone down for insurance. When do I lock in the new ins.? I thought after having surgery I would be in better health and thety would appreciate that but they said it works just the opposite. Did I understand you correctly?

sar4boy · 01-08-2009, 04:40 PM

You would think that they would like it if you were healthier but then they would pay for the dietician visits because those definately make you healthier.

For me the bcbs is under my husband so if I were to jump on the ins at work that would become my primary and the insurance here at work doesn't cover WLS. I am still concerned that any insurance might not cover complications from surgery later. Like if I have an issue 3-4 years out that is directly related to the surgery, is it going to be covered. No one really has an answer.

If I were you I would stay on the COBRA until after surgery but keep in mind that your bmi might be too low and so it would be a waste of time and money for you. I have a bmi of 38 and have diabetes, high colesterol, high bp, gerd and fibromyalsia and I am only 36 years old.

I was told that I would probably not be approved the first try and they were right. It only took less than 2 weeks for my dr's office to resubmit and get it approved with codes that were acceptable. But I just was approved and received my approval letter in the mail on Dec 24th (Merry Christmas to me!) and surgery is scheduled for the 21st. I will have to keep you posted after I go onto the other insurance next month or the following.

My doctors office knew so much about bcbs and was able to help me out a lot and understand what I needed to do.

addisonsgran · 01-09-2009, 06:42 PM

Quote:

Originally Posted by sar4boy

I too have bcbs of Il and am on the cobra. I did the whole 6 month thing, which they do not pay any of the dietician visits during this 6 month period but they did pay for the psych eval and the upper GI.

My problem is that my DH had the ins and the company closed in June but they paid the cobra for 6 months. We can pay for it for the next 12 but it is $1300 per month and my insurance where I work is obviously cheaper per month but will not cover the surgery.

So I started appointments in June, knowing that I would have to have it done by the end of Dec. Well, I had some ulcers that needed attention so that pushed back surgery. In the meantime the dr sent the paperwork in and it was denied because of wrong codes... my dr sent in new codes and they were approved.

So now that my story has gotten very long... I am going to have to pay one month or maybe two of the COBRA for bcbs and then I will be going on my employers insurance and there should be no pre existing clause since I am not letting there be a gap in coverage. (at least that is what HR is telling me)

I guess I would say that if you will not have a gap in coverage you should be fine.

I hope you are right. I have been on the phone to different agents, etc and they all tell me that gap means nothing(you have to inform new ins aboaut what you are going to do) They said that it all depends on health history and probably how you do after the surgery. It might be different for you because you are going to a group plan where mine is individual--but they did say they don't cover it, right? They all said I was taking achance on not being insurable afterwards. I do't know what to do-really want lap band.

addisonsgran · 01-09-2009, 06:45 PM

Quote:

Originally Posted by Vikkator

I think what you're asking is whether or not you'd be insurable through a new insurance company, is that correct? I would think that if you had the surgery, you'd be healthier because of it. In which case, I don't see why you'd need riders.

Also, you say your BMI is 34. I realize you have a couple of co-morbids, but 34 is a lot lower than what the guidelines normally are (usually 35+ with comorbids or 40+ without ).

Sometimes you might talk to someone at the insurance company who doesn't know all the facts. I'd call again and see what they have to say.

I was wrong about my bmi-I think it was more like 36 because I remember it was enough to make it with the comorbids. You would think that insurance companies would realize you are in better helath afterwards but I have been on the phone talking to all of them. They all say I am taking a chance on getting insurance later-can't lock it in before either.

addisonsgran · 01-09-2009, 06:47 PM

Quote:

Originally Posted by Julia_N

When I was on COBRA, I was told that if you had continuous coverage from your previous insurance that the new insurange company couldn't deny preexisting conditions. However, that was going from group policy to a new group policy, so maybe that doesn't apply to you.

Good luck!

I think that is when they both claim to pay for lap-band. I am going to an individal policy that does not cover it.

sar4boy · 01-12-2009, 07:17 AM

Sorry, was very busy all weekend to reply. I am on the board for the youth wrestling club and we had our tournament this weekend... Thank goodness that is over!

I am wondering if going from group plan to group plan might not be the difference. I do know that even things that aren't really elective like heart problems or asthma can give you a harder time of being insured but I thought that whatever Pre-existing you have when you go on a new insurance plan that it is that condition or things related to it that may not be covered. The problem is that if you are looking for insurance on your own you may find that insurance companies won't take you or you will pay a higher premium.

I don't plan on being on anything besides my employers plan as I never plan on owning my own business and my job is pretty safe as I work for the County.