[sandy13677]

Hi, my name is Sandy. I'm in the process of getting lap band surgery. My surgery date is June 17. I live in New York. Even though I have a surgery date, I'm confused about something. Maybe, you guys can help.
I was laid off from my job, but was hired by another company that took over my department. So, I still work in the same office, doing the same job, but work under a new company for my old company.

Since, I've been offically laid off from my old company, they offer to pay for our medical insurance for 3 months. At the end of three months, our new employer health care insurance( United Health Care) will begin. Now, with the old company I have BC/BS. I know under BC/BS the cover WLS. So, I schedule trying to get authorization before June 30( that's when my benefits ends). I've been preparing for the past 7 months( prior to knowing that my department would go to another company) to have my surgery.

So, I met with the insurance coordinator at a Hospital in NYC.
I aso, received a letter regarding my corbra insurance. I read it again this weekend, and it seems that my company has been paying Cobra for the continuation of my medical coverage.

So, I'm wondering with cobra( that I thought I didn't have) pay for my wls? I really need help!

Note: I haven't received authorzation yet. But the benefit coordinator assured me that it's possible to get authoization within 3 weeks. They know about my deadline, but do not know( like i didn't) that my old company has been paying for my medical, under cobra.

Thanks

Sandy

[Sfmini]

COBRA is the same coverage that you have now.
UHC does cover WLS and does cover the sleeve as well. BC/BS is the last hold out on the sleeve.

[sandy13677]

Thanks, sfmim...but I also mention to the coordinator that if I had to appeal, then I would pay corbra for a couple of months to cover my wls. She told me that cobra does not cover elective services. Now, i have to infom her about my letter. I'm really scared

[Sfmini]

If they deny it, just start up with UHC, you have documentation of the work you have done so they should cover it.
That said, you should check to make sure that you don't have to deal with the exclusions of pre-existing conditions.
When you think about elective, you think plastics, to me, WLS is really not elective for us, and your surgeon should back you saying this surgery is medically necessary.
Good luck!

[sandy13677]

Thanks....I will call the benefit coordinator tomorrow.

[GinaGurl]

good luck with your journey hang in there

[sandy13677]

Another question :What is a exclusions or pre-existing conditions? does that mean I have to wait a year or so to begin the process of auth for wls? Or does it mean that i have to wait 6 months? or i can't request auth at all....thanks