can't afford not to work

June 22, 2009 10:06 PM

What are my options for an six week absence from work for surgery with my employer? Is Aflac what I'm looking for?

De to the economy I had to leave a benefit-laden job with a national company to take a job with a MUCH smaller compan, and while my pay is good the benefits are NOT as good.

I am getting gastric bypass surgery, which the doctor tells me will keep me out of work for six weeks. In my last job we had short-term disability benefits where I would get 80% of my pay for five of the six weeks, using vacation time for the sixth week. My current job has no disability pay.

I can't make the mortgage and pay the out of pocket with six weeks unpaid from work and saving up that much time off or cash puts me on a minimum of a year waiting.

I've heard there may be some companies like Aflac that would provide this benefit but I can't imagine it would cover surgery. How could they profit if I'm signing up 30 or 90 or even 180 days before I plan to use it?

Do I have any choices other than wait or look for a better job?

posted by anonymous to work & money (8 comments total)

Short term disability is for short term disabilities. Not recovering from elective surgeries. I know with absolute certainty that my short term insurance wouldn't pay for recovery from a gastric bypass.

If this is not an elective surgery, there may be some options out there. But if it is elective, you'll probably have no choice but to not have it until your financial situation allows for it.
posted by Rendus at 12:33 AM on June 23 [2 favorites]

Talk to HR? Seriously, this is the kind of question that only your employer is going to be able to answer.
posted by valkyryn at 3:40 AM on June 23 [1 favorite]

IF you are having something done and you know about it already they might not let you join. I signed up with aflac about 2 or so months ago and they have a questionaire to fill out and if you have a surgery coming up they might not let you in.
posted by majortom1981 at 4:20 AM on June 23

I would call an AFLAC rep and ask. Frankly, your HR people may not know, because AFLAC is always sold to employees through independent reps rather than provided directly by HR. Most HR people, unless they have worked for AFLAC, are not intricately familiar with the benefit. I say this as an HR person who's worked in benefits for years.

Unfortunately, I have never heard of a short-term disability policy you can purchase, either at work our on your own, that would cover something like this. Additionally, to be covered by most short-term disability policies, you have to go through what's referred to as the Evidence of Insurability process. Typically, the first thing these companies look at to determine whether or not you're "insurable" is your BMI. If it's gotten to the point where you need gastric bypass, your BMI is likely too high for you to be considered for coverage (again, in most cases - I can't speak for every singly STD policy).

I'm sorry I've got nothing but bad news. I'm hoping someone else will chime in with some hope for you.
posted by pecanpies at 4:45 AM on June 23

Whichever independent short-term disability policy you end up buying--including Aflac--will have a waiting period, usually 12 months, before benefits kick in.

If your current employer does not offer short-term disability, you should purchase it through an independent agent.

Disability insurance is absolutely for recovering from elective procedures as well as accidents (including pregnancy). The main point of it is income replacement.

Aflac tends to be overpriced but the tradeoff is there is no exam required for its policies, including life insurance.

You need to contant an experienced independent insurance agent to ask about a short-term disability policy. That will be your best option for getting the information that you require. Different companies write policies different ways and an agent will be able to get your the best price on your coverage.

PS May I suggest you plan on being out of work at least two weeks longer than your doctor recommends? Make sure you talk with your coordinator/social worker about a realistic expectation for recovery. Surgeons tend to think in terms of the physcial body, not the mental/psychological recovery side. I don't think I need to tell you this, as a vetted candidate for gastric bypass, but you are about to embark on a very serious life-changing event. Be prepared for bumps in the road. And if you end up coming back in 6 weeks instead of 8, awesome. But leave yourself some wiggle room. Best of luck.
posted by FergieBelle at 5:25 AM on June 23

I've heard there may be some companies like Aflac that would provide this benefit but I can't imagine it would cover surgery. How could they profit if I'm signing up 30 or 90 or even 180 days before I plan to use it?

I love my Aflac insurance and consider it to be a great investment. But it's not health insurance, it's supplemental insurance. The purpose of it is to provide funds for the indirect costs of being ill. So it doesn't "cover surgery" per se.

There are are limits on which elective surgeries are included. At this point, even if they do provide benefits for gastric-bypass, it may be considered pre-existing, in which case they would not.

Their short-term disability insurance is an exception in that it is an employer-provided benefit.
posted by desuetude at 9:52 AM on June 23

Six weeks? Are you having open or lap? I was out for two weeks with mine, which was lap. According to my HR department, gastric bypass is NOT an elective surgery and is covered by short term disability. I chose not to use mine, as I had enough sick leave and vacation to cover it.
posted by elsietheeel at 10:56 AM on June 23

Your surgery would be a preexisting condition under a vast majority of disabiltiy insurance (DI) policies, at least as of today.

So unless you're covered before you first consult with a Dr. about it, it will not be covered for any consultations during the treatment period until you have waited out the exclusion period, which for a good number of policies is 90 days and 12 months, respectively. That's 15 months, total, 3 of being carerful to not bring this up with a doctor or take any medication which would treat the condition being treated by your surgery, and a year of waiting after your insurance is in force. The problem is that you'll also be subject to the reasonably prudent person test by many policies, as well. So, if a reasonably prudent person would have consulted with a Dr. about the condition during the treatment period, then you'll still be deemed to have a pre-existing condition.

I'm guessing that you have a medium or heavier occupation, which is why you'll need 6 weeks for convalescence.

While each situation is different and possible outcomes depend of specifics that we don't know until they happen, you're pretty much stuck with doing your best to save up for the time you'll need to be out of work. This is the most reliable way of managing your risk.

Unfortunately, there are not a lot of other options for you. Finding a better job would still subject you to the preexisting condition exclusion on your effective date. It would therefore also involve waiting.

It may seem that this is a harsh truth, but the reality of the situation is that it is effectively selecting against (antiselection) the insurance company's survival by signing up for insurance with the certain knowledge of a future claim. As a matter of survival, insurance companies need to be able to protect themselves from overt antiselection. Hence the pre-ex clauses and the added protection of prudent person wording.

That said, you can shop around and preview contracts for Individual DI policies. Or shop around for companies with good benefit packages that have short or no pre-ex exclusion periods in their DI benefit.
posted by valentinepig at 1:56 PM on June 26