I Am SO Bummed!

Thread Starter  

I have many friends who've had RNY done, but I knew that was not the procedure for me. I did not really look into lap-banding until a few weeks ago, and what I learned got me excited. I didn't have the misgivings about banding that I did about RNY, and I soon realized I'd made an unconscious decision to be banded.

However, my employer was in the process of switching our insurance coverage. We were with HealthAssurance and were switching to Keystone Health Plan. The change took effect on March 1. I just got my benefits information yesterday, and I was very disappointed to learn that any kind of bariatric surgery is excluded from my coverage. The worst part is that my plan under HealthAssurance DID cover bariatric surgery. If I'd have made this decision a year ago, it would have been covered.

I can't afford to self-pay or borrow the money for the procedure, so right now everything's on hold. I'm going to stay connected with this group, though, and not give up hope.

Are you in a union?

If so, your employer may have violated his agreement with the union by switching to a plan that is inferior to the previous one. Many times medical plans have requirements as per the union contract that must be met. If you are in a union, I would talk to your union representative. If you are not in a union, then I see little recourse other than to ask your employer, “why?”.

It is a shame that the insurance companies and the companies that purchase the plans do not realize that in the long run, bariatric surgery can be cost effective. The cost of surgery may be one large hit that eliminates the never ending multiple small hits of treating the complications of long term obesity.

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Thread Starter  

No union. I actually work for a community health center. What I don't understand with the insurance companies is that the health benefits from WLS in the long run offset the cost of treatment for obesity-related problems. Between my meds, routine testing and lab work, doctor visits, etc., even with insurance medical costs take a big chunk out of my paycheck. I would be a much cheaper, lower risk client for the insurance company as a healthy, normal weighted, lap-banded person.

I'm bummed with you,what else can we do?