Company refuses to get rider b/c of employee premiums rising

[tabalab]

HI, Everyone!

I got my denial letter from my company's current insurance (UHC) oer the weekend. :-( I was bummed, but was informed by HR last week that we were switching to Aetna, so thought perhaps I'd get a good chance with them. Unfortunately, I found out from a fellow co-worker (who is going throught the same process I am - we just didn't know it until today!) that our company is refusing to add the bariatric surgery rider because it would transfer a 30% premium increase to the rest of the employees for this coverage. I can understand not wanting to "penalize" - especially in this economy - the employees who don't need bariatric surgery, and probably don't even know what it is... but I thought I read somewhere that the company can approve this for the employee - does that mean that they can let the insurance company know to cover bariatric surgery for just "this" employee? Would they be able to do it for the two of us who are needing it? My co-worker and I already have our referrals from our PCP. I've got several support group sessions in already, too.

My husband's been VERY supportive of me so far in doing this, as long as insurance covers me. Now he and I are freaking out a bit, because we surely can't afford to do this all on our dime. The deductible and such, yes...but $15000? Does anyone know of any lending institutions that make medical loans? My center is currently trying to get a contract with CareCredit, since CapitalOne is no longer doing med loans.

I feel SO defeated! The company I work for is GREAT, smallish company. And I certainly wouldn't want my co-workers to have to fork out more money on an insurance rider they don't need...I guess I'm just feeling out of sorts since I found this out.

Any information you guys can offer will be very much appreciated. Prayers, too... :hurt:

[PattiDi07]

Care credit is a good option. I've had dental work done (extensive) and financed it through them.... zero interest the first 12 months, so I was able to pay it off within that time-frame. Good luck.... hugs and prayers to you!

[tabalab]

Well, I found out it's not the employee premiums that'll go up 30% - it's the company's premiums. I'm going to try to talk to the pres. Of the company (it's a smallish company, and very "family-like"). If I present the info to him in the right way, maybe he'll consider it, given there are TWO employees who've already started the process.

Does anyone know: is there a way he can get the rider on just certain employees to cut down costs? Or does it have to be across the board?

Thanks! Keep prayin'!

[tabalab]

Oh, and thanks, Patti for the reply! I've used CareCredit for dental work too. I'm just freaking out about paying another car payment (pretty much) to have the surgery. I know it'll be worth it, but I just don't have it! I'm open to all suggestions, though.

[MoOrLess]

I don't have anything helpful to add...but prayers and hugs! I can't imagine having to face this situation when you are already so far into things.....

[tabalab]

Thanks. MoOrLess. I'm feeling less panicked about it this morning, but still down - almost like I'm grieving. Sounds crazy, but that's the only way I know to describe it.

I have to go to my home office today for another reason, so I though I'd phone ahead and set up an appt w/my boss (the pres of the co.) And give him this letter I prepared last night. It basically goes into why I need the surgery, educates him on the differences b/t lbs & gbs. I think he's holding back not just because of the money, but because a former employee had gbs and had numerous complicvations from it--even tried to committ suicide in her office. So it would be understandable that he have a few hang-ups about it. But I just want to make sure he knows that what happened to her won't happen to me - and that my success rate long-term is drastically increased from what any bypass patientk4 would be (according to all the studies I've read). And hopefully when he realizes that it's not just one person needing this in the company he'll provide the rider. I'm also going to give him all the information from my bariatric center and the lapband.com informational site so that he can see that this isn't just on a whim for me.

So y'all pray that he keeps an open mind, and that the Lord grants me favor in this situation. I'm sure I'll be updating...this has become a bit of an outlet for me! ;-)

[firefighter30603]

Good Luck Tab. Let us know how things go! and remember he may say no today, but there is always tomorrow. Maybe you can talk to your coworker and ask her to approach him as well. You may already know this but there are a lot of sites out there that say how "unproductive" obesse people are and how WLS helps that. Not to say that you or any of the rest of us is unproductive but all employers want an increase in employee productivity so it may be worth at shot. GOOD LUCK!!! and i'll keep you in my prayers.

[Texasgal]

SOrry, I have no suggestions just sincere hugs and prayers for you and for your boss to have an open mind and kind heart.

I understand your grieving over this. It is a loss, a loss chance at a healthy and active life. Don't give up, I have heard the lapband companies themselves will make the operation available for less. You may want to get in touch with them if you can't get insurance to cover it.

[MoOrLess]

Thanks. MoOrLess. I'm feeling less panicked about it this morning, but still down - almost like I'm grieving. Sounds crazy, but that's the only way I know to describe it.

I have to go to my home office today for another reason, so I though I'd phone ahead and set up an appt w/my boss (the pres of the co.) And give him this letter I prepared last night. It basically goes into why I need the surgery, educates him on the differences b/t lbs & gbs. I think he's holding back not just because of the money, but because a former employee had gbs and had numerous complicvations from it--even tried to committ suicide in her office. So it would be understandable that he have a few hang-ups about it. But I just want to make sure he knows that what happened to her won't happen to me - and that my success rate long-term is drastically increased from what any bypass patientk4 would be (according to all the studies I've read). And hopefully when he realizes that it's not just one person needing this in the company he'll provide the rider. I'm also going to give him all the information from my bariatric center and the lapband.com informational site so that he can see that this isn't just on a whim for me.

So y'all pray that he keeps an open mind, and that the Lord grants me favor in this situation. I'm sure I'll be updating...this has become a bit of an outlet for me! ;-)

Sounds to me like you have everything in order - now we pray and wait. :)

[tabalab]

Well. Boss couldn't meet w/me so we had to talk over the phone. He did promise to read everything I sent to him, but told me not to get my hopes up- in this economy, they just can't afford it. AND, he did assure me of the confidentiality of talking to him (he knew I was divulging VERY private info), and he thanked me for trusting him enough to talk to him about it. So, while he was much more understanding than I thought he'd be, I pretty much have my answer-unless God moves in some way. So, I'm basically in a holding pattern till I decide what to do. Oh, he did say he'd follow up with me in about 2 weeks just to let me know definite...

Thanks for the prayers, y'all. Man, talk about drama!!

[Mloukas143]

What was there reason for denying you? You seem to fit the weight criteria, with or without co morbidities...that's odd, i would appeal it..good luck, i am still waiting for my insurance answer...nervous too!

[MoOrLess]

Well don't give up TAB!!!! If you haven't already -- join us on the exercise and weight loss challenges! They really are a great way to get started on your weight loss journey - banded or not. Put up a ticker and "piggyback" all of us - I did that for 2 years until I got a band - and I'm telling you, I was healthier and even better prepared for banded life so it was a win-win situation. HUGS - we'll pray for those miracles together!!!

Here's the current weight loss challenge:
http://band2gether.net/showthread.php?t=9306

and here is the exercise challenge:
http://band2gether.net/showthread.php?t=9342

You can check out the "new members" section for instructions on tickers, etc.

[tabalab]

Thanks, guys--my husband and I were just talking about that! :-). Your support is invaluable!

[Dieseldolly]

Tab, Good luck, I am in a little different situation. I had mine band done and my company took out the bariatric surgery 22 days before my surgery. I know what you mean by paying a car payment, I know it is worth it for me, but I am still fighting my company. My prayers are with you, I hope you can get something accomplished.

[Kim G]

I work for my bariatric doctor handling the insuurance pre-certs. To answer your question yes your employer has the right to have thee insurance company cover your surgery. I have had several patients go to their HR talk to them and get it covered. Sometimes it at the out of network coverage but it better the paying for the entire thing out of pocket.

For financing we use carecredit, medloanfinance or call allergan's 800 number and they have an option for financing. What they is work wth local banks in your area and get patients a decent interest rate. You need to make sure your surgeon is signed up with them. We also suggest home equity lines or loans. Something important to remember is that you would get get a loan for a car right? Aren't you equally or more important? So having another car payment would be worth it!

Best of luck!

[Mloukas143]

Hey Kim, I have a question real quick since we are on topic...if I had to get some type of loan for my surgery, how much (roughly) would my monthly payments be?

[Kim G]

Hey Kim, I have a question real quick since we are on topic...if I had to get some type of loan for my surgery, how much (roughly) would my monthly payments be?

Depending on your surgery cost, it could be like buying a KIA vs a BMW....

Seriously, it will depend on the current interest rate, the amount that you borrow and the term of the loan. You can use any standard on-line loan calculator to get this answer if you know all your variables.