It’s August! Did your bariatric surgery coverage change in July?

You have decided that this the year you are most definitely going to have weight loss surgery.  You remember checking whether your insurance company covers and you think they do.  But plan language  can change and there are plans which make the change in July.  No matter what month it is when you read this, you need to remember that possible trap which you can and should plan for and avoid. You and your surgeon’s office need to think ahead in order to put yourself in the best position to get your insurer’s all-important 

 

“WHAT DO YOU MEAN MY INSURANCE PLAN CHANGED?!?”

Simply put, do you actually have the same insurance coverage you think you have, or that you know you previously had? While many employer-sponsored health insurance plans change with the calendar year (January 1st), there are also a number of plan years beginning July 1st or at other odd times. If your insurance changed from one that excludes weight loss surgery to one that covers it, obviously that is to your benefit. But of far greater frequency and tragedy is the patient who had coverage only to find out he or she lost it when their employer renewed its insurance with a new company. This can happen even when the insurance company itself remains the same because often the scope of coverage changed.

Larger employers with Human Resources personnel or other similar professionals handling the transition from one insurer to another will usually try to make sure that anyone affected will know about changes in advance. But there are those employers who simply don’t know what is (or is not!) covered or they simply don’t care about the impact of the change. So what do you do? The best thing to do is examine for yourself what the coverage is, paying special attention to requirements or limitations for “weight loss surgery,” “obesity treatment” or similar items. Seek out whoever is responsible at the employer to confirm some basic things:

  • Who is the Insurer or the Claims Administrator?

  • How do I get a copy of my coverage booklet?

  • Are they Self-Insured or Fully-Insured?

A word of caution.  Remember that the policy is not the book identifying who the providers are (“Provider Directory”) or the 1 or 2 page summary sheet showing deductibles, co-pays, comparisons with your old plan or such similar things that many employers hand out when insurance plans changes. It is a longer booklet that details what is and is not covered and outlines your rights to challenge denials if they occur. Some employers and insurers make it easily available online giving you a user name and password .

You don’t have to tell them why you want this information nor do you have to disclose to them that you’re considering weight loss surgery. But you do have a right to know who your payer is and find out what is (and is not) covered under that plan. Be persistent and you’ll get what you need and what you have a right to have. Once you get it, review the coverage and exclusions carefully to determine whether you have insurance for your weight loss surgery.

Call us at 1-877-992-7732 / 1-877-99-APPEAL
if you need our assistance in learning about your coverage and rights.

601-C East Palomar Street #480 Chula Vista, California 91911 Tel - 877-992-7732 Fax - 844-384-9199

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