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Question on insurance change

AnonymousUserAAnonymousUser Posts: 49,578
edited 06/11/2012 - 7:24 AM in Back Surgery and Neck Surgery
I was hurt in an accident 3+ years ago. After a couple rounds of PT and 10 ESIs, my Dr. has suggested a two-level ALIF (L4-L5-S1). I was planning to have this done in early January (I meet with the Dr. again in two weeks to review a new MRI and to talk about specifics and scheduling).

Today at work, they announced that our group health insurance carrier is raising its rates for 2009, so my company has decided to drop that carrier and we'll be under some different insurance plan as of 01/01/09. (No idea which company it may be yet.) I'm worried how this may affect the surgery. Does anyone here have experience with this sort of thing? Two things worry me:

1. I *hope* that the new insurer couldn't exclude the surgery as a pre-existing condition, since I have had other insurance all this time and am only switching now b/c of my employer. Should the new insurance company still cover the surgery?

2. If the new company requires preapproval before surgery, how long does that take? Will I need to hold off on the surgery until later so the company has time to say yes or no on it? I wanted to have it during the first week in January.

I've never had problems with the previous insurer paying for PT, ESIs, etc. Changing carriers right before going under the knife has me pretty anxious.

Thanks for any insights you can give!

p.s. This is in the U.S.


  • Thats a very tuff question.
    I personally have not had to endure that.

    I know a few people that have and it all depends on who the insurance carrier is going to be. Some will pick up pre exsisting some won't. Depends on the medical issue for some of the companies.
    Since surgery is already scheduled that may be a plus I totally am not sure on that.

    I would log on to the new insurance carriers website and check out all the fine print.
    Did they hand you all out paperwork yet or no???

    Also mabye discuss it with human resourses. They probably have alot more information on what can and cannot happen.

    I wish you the best of luck!!
    Let us know what you find out.
    I imagine other people would be interested to going through the same thing just browsing the boards.

    Take care
  • Endy, any chance you can move the surgery up and have it before the end of the year? Do you know if it will be an HMO? Most HMO's do not have a pre-existing clause. Definitely talk to HR. Good-luck, >:D< Sue
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  • your right i was going to post move the surgery up like if there is a spot available just after xmas.

    i know that stinks but it would work just incase, and hey if the dr has a opening take it and get it over and done with. then there wont' be any worries...

    hope more people throw you out ideas to put your mind at ease till you can talk to someone at work hun.

    terri >:D<
  • Typically, when an employer changes insurance companies, pre-existing conditions are not excluded. However, it would be in your best interest to verify that with the new insurance company. You could also have your company's human resource department look into this - that is what they are there for.

    Pre-approval times can vary, depending on insurance companies. I have seen surgeries approved as quickly as 1 hour, however in the case of my fusion surgery it took close to 2 weeks (different insurances).

    While the suggestions for scheduling your surgery in December are good ideas, there is another issue to consider, especially if you will be in an HMO. I had my surgery done while under my wife's insurance. Since then, she lost her job. Luckily, she started a new job this week, so we are now covered by different insurance, which happens to be an HMO.

    I have an appointment scheduled with my surgeon before Thanksgiving. While he is a participating provider in the HMO, the insurance company told me that I have to establish care with a primary care physician and get a referral for my surgeon before that appointment. If I don't, they won't cover the appointment. As no surprise, my PCP of 18 years is not a participating provider, so I have to see someone else for the referral.

    Before jumping into anything, you should check with your surgeon and find out if any post-operative appointments are covered from the surgery. In my case, it is for 3 months. If your surgery costs do not cover any follow-up appointments, then you may need to see a PCP to get a referral to your surgeon before the new insurance would cover those follow-up appointments.

    I'm not trying to scare you. I only want to make sure you have considered all the issues and know what you will need to do for your surgery and recovery period before making any rash decisions.

    Good luck with everything. :)))
  • side of this - Your Human resources should be able to advise.

    This happened to me, so i appreciate your concerns but as was not my fault the insurer was changed and I was pre receiving treatment.
    HR told e not to worry and my company would foot the bill if necessary. I made sure i got that in writing then realxed.
    I think there were a few hiccups around my case but as the end user here, I have all my care paid for.

    Good luck.
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  • Thank you for the helpful advice. I should know in a couple weeks what the new company is. I think MarkR is right, that a pre-existing condition won't be excludable, but I'll check with HR and the rep from the new insurer to find out for sure.

    I may wind up delaying the surgery till later in January, just to have a little more breathing room for the preapproval process.

    Moving the surgery up to December would cause all kinds of scheduling problems, so that's not an option. Plus, I'll be able to use a flexible spending account as of Jan. 1 to pay for the co-pay/deductible.

    Thanks again!
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