Is It Time to Get New Insurance?
Open enrollment is here.
Hi Everyone!
At the end of the year, something important happens in the U.S. No, it’s not Christmas. This happening is less fun than that.
October until December is the time for Open Enrollment.
Open Enrollment, if you don’t already know, is when you can freely change your medical insurance without a significant life event (such as marriage, divorce, babies, losing a job, getting a job…you know, big things like that).
Depending on your age and work status, you may have anywhere from no choices to multiple choices of insurance you can pick from for the next year.
For example, I’m covered under my husband’s insurance, and the company we work for (I work there too but don’t carry benefits) has no other option for medical insurance than what they offer. This is because they are self-funded. We get one insurance—their insurance.
However, many companies offer a range of fully-insured plans, names you’d recognize; BCBS, Aetna, UHC, Cigna, and Kaiser, to name a few.
If you’re under age 65 and are self-employed or otherwise not offered insurance, you can buy commercial insurance through the Marketplace.
These choices open up for you come October, and there are a few things to consider if you’re contemplating new insurance:
If you’ve had success with your current insurance, have been approved for surgeries, or getting to that point, then switching plans will wipe all of that away.
If you’re in the middle of treatment and you’ve submitted for surgical preauth, you’re working on your surgeries with good promise for approval; consider that if you change insurance plans, you’ll have to start over at the beginning of the year with your new insurance.
Your new insurance will not consider any approvals or preauthorizations from your previous insurance.
If you’ve had good progress with your current insurance, consider keeping your plan. Of course, you have to weigh all of the medical conditions and ongoing treatment of you and any of your family who are insured under your plan.
When to consider changing plans
But my insurance plan has denied me coverage and has denied a peer-to-peer review. I’m now working on my second (or third) appeal!
If you’ve had significant trouble getting any treatment for your Lipedema (for example, they’ve considered it investigational/experimental and won’t budge), you can decide to change plans over to insurance with plan language for Lipedema Reduction Surgery.
Now, I’m all for fighting the insurance and getting a win. However, treating our bodies comes first. There are more progressive health plans which already have benefit language and are starting to cover liposuction surgery for Lipedema.
Contemplate your choices carefully. Research each insurance plan and see if they have language in their benefits for Lipedema. You can even check to see if they are in-network with some of the surgeons who treat Lipedema. Do some extra footwork and see if any patients have experienced problems with their approvals.
Also, take into consideration any of your family members who are under the same plan and if they will be negatively affected by a change in medical insurance.
Researching this takes a lot of footwork. However, I’d rather see you go into the new year with informed choices about your insurance. Your up-front work can save you tens of thousands of dollars and get you moving forward in treatment.
If you’re looking into switching your insurance or have any questions about changing plans, please comment below.