Advice on Switching Insurance (getting off employer-sponsored)

[sarahfelldown]

Hi again,

I've been pecking around the boards and see that many of you have switched to out of pocket insurance because your employer-sponsored plan wouldn't cover your surgery. I'm wondering if anyone has advice on how to go about getting info on the plans available? Basically I know I won't be able to switch from United Healthcare (my employer's plan) to an individual plan on Blue Cross Blue Shield of Oklahoma (my surgeon's recommendation) until open enrollment begins this November/December, but is there any way to get pricing and coverage info on BCBS's plans in the mean time? I can view the plans on their website if I fudge the answers to their preliminary questions so that it deems me eligible to enroll mid-year (which I'm obviously not trying to do...just trying to find info), but I'm not sure if the pricing and coverage on those plans is the same as it'd be when I do open enrollment? They don't really have email or chat support so is my best bet just to call someone (ugh, I'm no good on the phone lol).

Also, my surgeon told me to make sure the plan does not exclude orthognathic surgery, but can I mention that in a call with someone or would it be considered pre-existing and denied at that point?

Thanks for any advice or personal experiences you might share!

-Sarah

[snapdresser]

All of these are great questions. Unfortunately, it looks like your best option is that dreaded phone call. The BCBS reps are typically very knowledgeable and helpful. If you bring up this surgery during the phone call, I highly doubt they'd flag your account for a pre-existing condition. But let us know how it goes; maybe other people could benefit from hearing what you find out.

[Ravenclaw]

Also, my surgeon told me to make sure the plan does not exclude orthognathic surgery, but can I mention that in a call with someone or would it be considered pre-existing and denied at that point?

Because of the Affordable Care Act (Obamacare), you can no longer be denied coverage due to a pre-existing condition. Health insurers also can't limit the coverage you receive based on a pre-existing condition.

[snapdresser]

Because of the Affordable Care Act (Obamacare), you can no longer be denied coverage due to a pre-existing condition. Health insurers also can't limit the coverage you receive based on a pre-existing condition.

Good point, Ravenclaw!

[sarahfelldown]

Awesome! I was hoping that was the case but I haven't dug into the pre-existing rules in the ACA. That's great news! Thanks!