Bariatric legislation---changes didn't copy ;(

Sorry, I have to leave and my previous message has not posted to the list yet, so just to let you know, when I copied the PDF, the crossed-out changes did not copy over. In ALL cases where you see eighteen months (18), it has been crossed out indicating that was the change they made.

Okay, let's try this again. Apparently I did something wrong with my initial message, so here goes Hello, I haven't been on here much, but I did see the post about Dr. C's office saying that the new legislation only applies to state employees. That is incorrect and they aren't reading carefully. I have a copy of the legislation and you can read it for yourself. There are different sections. One applies to 'an individual covered under a health care plan', one is for HMO's, and there is another one...... It's a dry read and a lot of legal jargon, but it's pretty clear what they are saying. SENATE ENROLLED ACT No. 266 AN ACT to amend the Indiana Code concerning health. Be it enacted by the General Assembly of the State of Indiana: SECTION 1. IC 5-10-8-7.7, AS AMENDED BY P.L.196-2005, SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2006]: Sec. 7.7. (a) As used in this section, "covered individual" means an individual who is covered under a health care plan. (b) As used in this section, "health care plan" means: (1) a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or (2) a contract entered into under section 7(c) of this chapter to provide health services through a prepaid health care delivery plan. (c) As used in this section, "health care provider" means a: (1) physician licensed under IC 25-22.5; or (2) hospital licensed under IC 16-21; that provides health care services for surgical treatment of morbid obesity. (d) As used in this section, "morbid obesity" means: (1) a body mass index of at least thirty-five (35) kilograms per meter squared, with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, C o p y 2 SEA 266 -- CC 1+ or diabetes; or (2) a body mass index of at least forty (40) kilograms per meter squared without comorbidity. For purposes of this subsection, body mass index is equal to weight in kilograms divided by height in meters squared. (e) Except as provided in subsection (f), the state shall provide coverage for nonexperimental, surgical treatment by a health care provider of morbid obesity: (1) that has persisted for at least five (5) years; and (2) for which nonsurgical treatment that is supervised by a physician has been unsuccessful for at least eighteen (18) six (6) consecutive months. (f) The state may not provide coverage for surgical treatment of morbid obesity for a covered individual who is less than twenty-one (21) years of age unless two (2) physicians licensed under IC 25-22.5 determine that the surgery is necessary to: (1) save the life of the covered individual; or (2) restore the covered individual's ability to maintain a major life activity (as defined in IC 4-23-29-6); and each physician documents in the covered individual's medical record the reason for the physician's determination. SECTION 2. IC 16-40-3-2, AS ADDED BY P.L.196-2005, SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2006]: Sec. 2. (a) As used in this section, "major complication" means a complication from surgical treatment for morbid obesity that: (1) requires an extended hospitalization, additional surgical treatment, or invasive drug therapy within thirty (30) days of the original surgical treatment; or (2) results in a permanent disability. (b) As used in this section, "serious side effect" means a nutritional deficiency that requires hospitalization or invasive therapy. (c) A physician who is licensed under IC 25-22.5 and who performs a surgical treatment for the treatment of morbid obesity shall do the following: (1) Before performing surgery, discuss the following with the patient: (A) The requirements to qualify for the surgery. (B) The details of the surgery. (C) The possible complications from the surgery. (D) The side effects from the surgery, including lifestyle C o p y 3 SEA 266 -- CC 1+ changes and dietary protocols. (1) (2) Monitor the patient for five (5) years following the patient's surgery, unless the physician is unable to locate the patient after making reasonable efforts. and (2) (3) Report before June 30 and before December 31 of each year: (A) to; and (B) in a manner prescribed by; the state department any death, or serious side effect, or major complication of the patient. (b) (d) The A report required in subsection (a) by subsection (c)(3) must include the following information: (1) The gender of the patient. (2) The name of the physician who performed the surgery. (3) The location where the surgery was performed. (4) Information concerning the death, serious side effect, or major complication and the cir****tances in which the death, serious side effect, or major complication occurred. (5) The comorbidities, body mass index, and waist circumference of the patient: (A) at the time of the surgical treatment; and (B) thirty (30) days, ninety (90) days, and one (1) year after surgical treatment. (6) Whether the patient has had previous abdominal surgery. SECTION 3. IC 16-40-3-3, AS ADDED BY P.L.196-2005, SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2006]: Sec. 3. (a) The state department shall collect and maintain the information reported to the state department under section 2 of this chapter. (b) The reports made under section 2(a)(2) section 2(c)(3) of this chapter are public records and are confidential. However, the state department may compile statistical reports from information contained in reports made under section 2(c)(3) of this chapter. Any statistical report is subject to public inspection. However, the state department may not release any information contained in the reports that the state department determines may reveal the patient's identity. SECTION 4. IC 27-8-14.1-4, AS AMENDED BY P.L.196-2005, SECTION 5, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2006]: Sec. 4. (a) Except as provided in subsection (b), an insurer that issues an accident and sickness insurance policy shall offer coverage for nonexperimental, surgical treatment by a health care C o p y 4 SEA 266 -- CC 1+ provider of morbid obesity: (1) that has persisted for at least five (5) years; and (2) for which nonsurgical treatment that is supervised by a physician has been unsuccessful for at least eighteen (18) six (6) consecutive months. (b) An insurer that issues an accident and sickness insurance policy may not provide coverage for a surgical treatment of morbid obesity for an insured who is less than twenty-one (21) years of age unless two (2) physicians licensed under IC 25-22.5 determine that the surgery is necessary to: (1) save the life of the insured; or (2) restore the insured's ability to maintain a major life activity (as defined in IC 4-23-29-6); and each physician documents in the insured's medical record the reason for the physician's determination. SECTION 5. IC 27-13-7-14.5, AS AMENDED BY P.L.196-2005, SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2006]: Sec. 14.5. (a) As used in this section, "health care provider" means a: (1) physician licensed under IC 25-22.5; or (2) hospital licensed under IC 16-21; that provides health care services for surgical treatment of morbid obesity. (b) As used in this section, "morbid obesity" means: (1) a body mass index of at least thirty-five (35) kilograms per meter squared with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes; or (2) a body mass index of at least forty (40) kilograms per meter squared without comorbidity. For purposes of this subsection, body mass index equals weight in kilograms divided by height in meters squared. (c) Except as provided in subsection (d), a health maintenance organization that provides coverage for basic health care services under a group contract shall offer coverage for nonexperimental, surgical treatment by a health care provider of morbid obesity: (1) that has persisted for at least five (5) years; and (2) for which nonsurgical treatment that is supervised by a physician has been unsuccessful for at least eighteen (18) six (6) consecutive months. (d) A health maintenance organization that provides coverage for basic health care services may not provide coverage for surgical C o p y 5 SEA 266 -- CC 1+ treatment of morbid obesity for an enrollee who is less than twenty-one (21) years of age unless two (2) physicians licensed under IC 25-22.5 determine that the surgery is necessary to: (1) save the life of the enrollee; or (2) restore the enrollee's ability to maintain a major life activity (as defined in IC 4-23-29-6); and each physician documents in the enrollee's medical record the reason for the physician's determination

Tania, I dont understand much about this but I do think u misunderstood what I said. The drs office told me its for only ppl that are covered the States Insurance...this means medicaid and medicare etc. Not state employees!!! Most state employees have Anthem Insurance. Its my understanding that the State of IN has several different plans under the umbrella of State programs/plans of insurance. Such as hmo ppo etc. I only know what the drs office told me. She said that this state policy only regulates their own programs. That it doenst regulate all insurance companies. I guess for those with questions could call their own insurance companies or their own drs and ask if they have any changes after July 1st is here. I hope this clarifies what I was saying....Not that its written in stone I just know this is what my drs office told me. They could be wrong everyone has their moments. Mariah

Mariah, I responded to your earlier post...this legislation applies to all insurances that cover WLS in Indiana. The new rules go into effect on July 1. I have an HMO and I am not a state employee and it is how I got approved now instead of in October. I'm sure Dr C's office will get things right for you. Good Luck!!

I see the word state in there, and as a rule ins companies do follow whatever medicade does...so if ins co have not they will soon be doing the same...i also see (18) (6) months diets and showing 5 years obesity. so if you have only been obese 4 years and 8 months you have to wait 4 more months.... not sure i can copy and paste all of that...cos the 18 and 6 are both right there together., rather confusing,. to say the least

Hi Angie---I mentioned this, but I think it may have gotten overlooked. I had to paste this in from a PDF and when I copied it over, all of their strikethrough changes did not carry over. In all cases the eighteen months (18) has been struck through and replaced with six months (6). Yes, you also have to have been overweight for at least 5 years-----is that really a problem for anyone, LOL ??? I think I'm going on 30 years being overweight and it showing in various doctor's records. All I know is that I have employeer purchased insurance through M-Plan and my doctor's office, my surgeon's office, and Dr. Eve Olsen's office (who, by the way, testified several times for this change) are getting my packet together to submit again on the 29th, so it is at M-Plan when they get back from the holiday on July 5th. I'm guessing the mail will be very heavy that day If anyone would know for sure any exclusions, it would be Dr. Olsen. On the south side at least she is THE Diet Doctor and where St. Francis refers for the 'physician supervied weight loss' program. She is excellent! She is very familiar with the legislation and what was involved on the inside to get it changed. She is also very familiar with where I work and the kind of insurance I have. If me, my doctor's office, and my surgeon's office was misinterpreting this and if this was restricted to only certain situations, she would have told me. One thing more I did find out this week. Some insurance companies are trying to get around this by increasing their co-pays. In some cases, they have increased to 50% of total costs!!! So, even though they may approve you now, you still may have to take out a loan to pay for it. This varies considerably between insurance companies and what employers have purchased through the companies. Bottom line, everything is changing fast. I would keep communication open with my doctors and insurance so you go into it fully aware. I'm just trying to offer some hope here. ;) Please don't give up and I would ask them to double check their information. Tania