Georgia Morbid Obesity Surgical Intervention Act

Has anyone ever heard if Georgia has a law requiring health insurers to provide coverage for the treament of morbid obesity when medically necessary? I have been doing some research on the web and came across where this act was brought up in Georgia Legislature a few years ago, but I am not sure if it was voted as a law. As some of you know, I was approved by Independence Blue Cross/Blue Shield for surgery for Jan. 18, 2005. Then last week BC/BS informed me that they would not covered it because my plan won't cover this type surgery effective Jan. 1, 2005. I have filed a complaint with the Ga. Insurance Commissioner and I am investigation where any laws in Ga. applies to WLS.

I have no idea but would love to help you look as well as read any information you might come across. I know how you feel.. happened to me too. Melissa

Hi Michael: Yes there is a Georgia Law, here is a link to it http://www.legis.state.ga.us/legis/1999_00/leg/fulltext/sb24.htm . When I first started trying to get approval for this surgery I had UHC of GA through my husbands employer. I was first told UHC covered the surgery then upon closer review, the surgery was an exclusion by my husbands employer. I did some research and found this law on the GA books. What this law says is that the insurance company MUST offer coverage for the weight loss surgery. So as in my case the insurance company did offer the coverage to my husbands employer, they chose not to pick it up. I talked to my husbands HR person and they explained the additional premium to include the weight loss surgery "rider" was too expensive. So to me this is a loophole that needs to be fixed. The coverage SHOULD be offered to the employees, not the employer. I immediately wrote to my congressman about this issue and how the law needs to be changed. In California they have a similar law that is worded much better so that the coverage has to be offered to the insured employee, not the employer. I have that information at home, if you need it let me know (I am at work right now). I was ready to fight, fight, fight!!! Then I found out that my employer would cover it, so I changed insurance plans as soon as I could. You might also check out www.obesitylaw.com they have some useful information and articles there. GOOD LUCK to you and if I can be of any help, let me know. Kelly S

I was told that these laws do not apply to self-insured companies. I too thought my company insurance would have to pay for the surgery because Maryland has the same law and that is where our HQ is. When I called the Insurance Comissioner there, they told me that many companies are self-insured and these laws do not apply to them. So even though you think you have BC/BS you actually just have a plan that the company tailored to them and they are paying the medical bills. BC/BS is just handling the plan and paperwork. My company will pay for drug addiction treatment but not WLS. Go figure.

I believe that Dr. Celio Burrowes helped to "word" part of the Ga. law that is spoken of a couple of posts above me. He spoke to our support group recently and said he is now working with a state rep. to word another bill that will close up any loopholes....that will "mandate" employers provide coverage for their employees. Everyone should be writing their congressmen and women. Even if we've already had surgery, the tummy tucks that were once covered will no longer be. He state rep. he is working with has a sister and another relative that Dr. B performed surgery on. He's asked all of us to help by writing those that might have a final say in the vote. I really appreciate all the websites offered and info. It's so helpful for us to stay informed.

How do you know if your insurance company is self insured?