I Got a Better Job, But I’m Afraid My New Insurance Won’t Cover a Scheduled Surgery

Thought you guys or the readers might have some thoughts on this. I was headhunted and offered a position with better pay, a better bonus, and more interesting responsibilities than at my current one. The thing that’s stopping me is my insurance.

I have jaw surgery scheduled for six months from now, and I’m getting it because my current employer has great health insurance and I was pre-approved for every piece of two complicated operations. All I will pay is $250 for an overnight stay at a hospital.

I had braces/retainers/appliances as a kid, and although my teeth ended up straight, my upper jaw was narrow, and my teeth wore unevenly. Ever since I was 18 my dentists have told me to get jaw surgery, but it costs about $50K here in the Northeast. I am in braces again and was happy as a clam until I got this offer.

The new company uses BCBS rather than Aetna, my current insurer, and my surgeon and orthodontist would need to submit all the paperwork again. Thanks to the Affordable Care Act, BCBS cannot choose to issue a blanket denial due to it being a pre-existing condition, but there is also no guarantee that BCBS would cover the surgery. If they don’t, I can’t afford it on my own. I suppose I could take out a loan, but I don’t want to. — D.

D., if you decide to leave your job, you may be able to keep your current insurance plan via COBRA before opting into your new company’s health care plan. Via cobrainsurance.com:

Under COBRA, if you voluntarily resign from a job or are terminated for any reason other than “gross misconduct” you are guaranteed the right to continue your former employer’s group plan as individual or family health care coverage for up to 18 months, at your own expense. In many cases, your spouse and dependent children also are eligible for COBRA coverage, sometimes for as long as three years.

Maintaining coverage under COBRA will come at a higher cost to you, though it might be worth it since you know your plan will cover your surgery.

When you’re on COBRA, no longer will your employer be picking up a big chunk of the monthly premiums. You’ll be responsible for paying the full amount, plus an administrative fee of up to 2%. You’ll have to weigh your ability — and desire — to pay the extra expenses against your and your family’s need for health coverage and the financial dangers of going without it.

Essentially, under COBRA, you’ll be in charge of your share of the premium PLUS your employer’s share, and any administrative costs. Look into this to see if COBRA coverage is an option available to you.

You could also explain the situation to your new employer, who may be willing to cover the costs of the surgery if their insurance plan, for whatever reason, doesn’t end up covering the surgery. Tell them that you are interested in the position, but the thing holding you back at the moment is the surgery you have scheduled. They obviously want you to be a part of their company since they took the time to headhunt you. Perhaps they are willing to help you sort this out so that you won’t have to pay anything out of pocket. One good thing is that since it’s a non-life-threatening procedure, you can reschedule the surgery until you get this sorted out.

Perhaps there are readers out there who can speak more authoritatively on this health care issue! Please share your thoughts if you have them.

Photo: Specialty Hospital

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