Anyone know about the mandate on insurance and bariatric surgeries?

[zimmersdreamer 0]

Hi, I am new to the search for lap banding and have contacted my insurance policy to see if I am covered. the surgery is not covered. When I was looking for an insurance that does so I could either switch or add to it I found that Indiana has a state mandate to have bariatric surgeries included in group health plans. (I live in Indiana) Does anyone know what the mandate says? Do I call my insurance back and ask again stating that I know we are in a mandate state? It seemed like the CSR had to look up the information, could she have missed it because of the wording? How should I ask the next time I call?

[zimmersdreamer 0]

here are some sites that i have found...

State laws on insurance coverage for bariatric sur... [surg Obes Relat Dis. 2005 Jul-Aug] - PubMed result

Insurance Coverage | Bariatric Surgery and Weight Loss Services | St. Francis Hospital, Indianapolis

Countervailing factors seem nearly certain to boost the number of weight loss surgeries during 2004, however. Legislatures in several states are known to be considering bills that would mandate coverage for obesity surgery. These are Illinois and Ohio. If laws are passed there, they would join the ranks of six states--Louisiana, Virginia, West Virginia, Georgia, Maryland, and Indiana--that already have mandated such coverage. Passage of benefit mandates such as these states have makes it much harder for insurers to deny coverage to persons who fit the prerequisite profile, and to impose further restrictions on coverage for obesity surgery, but does little to address levels of reimbursement for the surgery to hospitals and doctors.

(from Liability insurance premiums on bariatric surgery soar. | Goliath Business News)

good luck and please post if anyone else finds more info!

[skinigrl2b 1]

That's an interesting link - thank you for sharing. I live in GA, and got a bit excited when I started to read this.

My concern is this: even though the insurance company is required to offer the coverage, does the company (aka my employer) have to elect to purchase the coverage?

My employer's plan specifically excludes WLS of any kind, so I'm assuming that it's still ultimately up to the plan administrator whether to offer it to employees or not.

[ParrotheadCathy 0]

My take is that the insurance companies have to offer it as a covered item but the employer would have to elect it because they would have to pay for it. Here's why I say that:

However, none of the state laws that were passed "mandate" coverage, but rather "recommend" coverage or mandate that the insurer offer the coverage, for which the insurer can charge additional premiums.

This is from the first link.

So I take that to mean that some states have passed laws that say insurance companies have to offer coverage for bariatric surgeries but nowhere does it require an employer to elect (and pay for) the coverage. If your insurance has a written exclusion (as mine did) then, as skinigrl says, you're still out in the cold for sure!

[zimmersdreamer 0]

hey Cathy thank you for your clerification. I knew there had to be a loop hole, sadly my employer has decided not to include it and it is not an option for me to add it as a rider.

skinigrl2b- Im sorry if I gt your hopes up. Maybe if you call your employer than you can have more luck than I did.

for me- I found out that I am covered from medicaid and will prosue that rout. I hate doing it that way but the way I look at it I will be a better mom in teh long run for it.

[skinigrl2b 1]

hey gals - at least we know someone is trying to help...but until the employers are required to choose it and offer it to employees we'll still be at their mercy. Dreamer- no worries- I am glad to know about that law.

Good luck to us all! We'll get there eventually!!