Caifornia Law and Insurance Exclutions

Long time no post- thought I'd visit with some info I found out about this week.
California has a law on the books that I just found out about. Did you know, that EVEN if your medical insurance has an iron clad bariatric exclusion that California state law says the HAVE TO COVER IT if it is medically necessary per NIH (bmi over 40 and over 35 w/comorb.) standards. So if they deny it it must go to a medical review and more than likely be overturned.
Miss you!
Lou

Hey, there and how are you.  How is Cousin Vitto.  (LOL) .

Hope that this finds you well.
Liz

Louise 

 Long time is right.  It Sure is nice to see you.
I sure hope you pop in more often. Hope your doing well and staying healthy.


Take care and don't be a stranger.

Wow, when does that go into affect?  09?

it is current.
It is a little known secret that insurance does not want you to know.
Ask for an appeal-let it go to an extrernal review.
IF IT IS MEDICALLY NESSICARY THEY CAN NOT DENY IT.
Call your insurance and ask....I did and made them read word for word the process.
They wouuld not fax me but a nice rep that helps union families told me why- so now I an sharing with my OH family.
Good Luck
Lou

How does it get to an external review? and Jenn where is the class action suit?

Gina

You need to contact your insurance. Mine has been helpful each step of the way.
Good luck sweetie,
Lou

Louise,
We have missed you so much around here....hope to see you more often.

I now work full time and don't have much time to post. I am very active with my children in their sports.
Thank you for missing me.
I am waiting to get a band-over my RNY. As you all remember my slow weight loss was a very sore subject....well turns out when I had an EGD (@ 6 mos post-op) the Dr dilated my Stoma making the opening so wide that I had almost no restriction. Well long story short I did not gain all my weight back ,but a medication I was on for depression added enough weight for me to qualify for a re-do. I am at 36 BMI but have severe arthritis in my right hip and almost no cartilage in the joint, I walk with a limp and in constant pain. I do not want to get a full-on revision but have the restriction that I enjoyed my first 6  months post-op.
My husbands HMO policy has an iron clad exclusion, but a kind rep who felt sorry for me told me about the law. So I am ready to fight and have it go to an external review to get over-turned. I figure I would share this info to others who might need it.

Have you looked into stomaphyx.  It is specifically for bypass patients who's stoma's have stretched.  It is fairly new but FDA approved and doing well.  The procedure is done endoscopicallly as outpatient.  Much less invasive.  I see some CA surgeons who do this procedure including one at UCI. Hope this is helpful.  Your info will be helpful for a friend who is trying to get her first surgery at UCI.