Today is my 1 month “surgiversary.” Yes, it’s been an entire month (4 whole weeks) since my surgery. I am very happy with my progress to this point and look forward to what the future still has in store for me. That’s the good part of today.
Then there is the insurance issue. I’ve been on COBRA since quitting my job in September, 2008. I had a maximum of 18 months coverage, which means my current policy expires March 11, 2010. So earlier this month I went online and worked up a quote through a National insurance carrier – the same one my COBRA policy is through. The quote was within reason (actually a bit less than what I’m paying currently) so I filled out the application and submitted it. The application was incredibly thorough asking not only for doctors I’d seen but medications I’ve taken and am currently taking, who prescribed them, dates I’d taken them… and surgeries. Naturally I listed the WLS procedure I had last month. I figured the fact that I noted it was a “self pay” would be a good thing.
Yesterday I receive a large envelope from them. I figure this is good news, just like when you get the large envelope from a college or university you’ve applied to. It was partly good. Yes, they could offer me a policy, but at their highest tier (4). The premium per month is roughly 4 times that of the quoted monthly premium. Their reason for the tier was that my “weight is elevated for height.” So I fumed. All I could think was how did they overlook that I just had surgery to help with the weight? So I spoke to my mom last night as she’s had far more dealings with insurance companies (and once upon a time actually worked for this one) and she suggested I call them even though I couldn’t file an official appeal over the phone (and I don’t really have time to appeal either).
Earlier I spoke to a very nice underwriter named Mary who pulled up my file and reviewed it while we were on the phone. I asked her if the fact that I’d had gastric bypass last month, and that I’ve already lost over 30 pounds was taken into consideration at all. She said the fact that I’d had the surgery last month was why I’d been put into tier 4! I was flabbergasted. Apparently I’d have to be 3 years post-op in order to be considered for a higher tier! Insanity! I thanked her for her time and called my mom with the news.
Am I happy with the outcome? Hell no. Is there anything I can immediately do about it? No. I can’t be without insurance and there is no more time to apply to another company. So I will bite the bullet and pay this horrific premium until I become employed and qualify for insurance through a group plan.
However this does bring serious issues to mind. In my opinion having a surgery for weight loss may cost $X up front, but in the long run it costs the insurance companies less for other co-morbidities that the patients would have. That would make the insurance companies’ pay out for claims for WLS patients less over time. Consider all the co-morbidities that my insurance might have needed to pay if I’d not had the surgery: hypertension, diabetes, sleep apnea supplies and/or surgery, knee and/or hip replacement, etc… Now my chances of all those are drastically reduced. This is just another example of how the US healthcare system needs an overhaul. I’m actually trying to figure out where to send a letter/email to those working on the healthcare issue so they have even further evidence of how the insurance companies are treating the insureds.
If I could still drink I would most likely have a glass of wine. But as alcohol is off limits for another 11 months, I think I’ll just enjoy some water. Or a nice protein drink. Regardless, I’m relaxing the rest of tonight.
