indiana insurance madate on bariatric surgeries

I have just started the process of getting approved for the lap band surgery. I called and asked my insuracne and they said NO. Durring my search for a new (or secondary) insurance i found that there is a state mandate on insurnaces to cover bariatric surgeries. I have a group plan PPO (through Health Smart) I have not called them back due to the holidays but have been advised that having the Dr office call might get better results rather than Me calling.

Has anyone heard or know anything about the mandate?
is this something I have to call my employer about adding as a rider?
Has anyone one faught the insurance because of te mandate?

thanks in advance for any information!

It usually depends on the insurance. If a company is self-insured, they often have the right to opt out of those types of rules. The company might be self-insured, and still be administered through a third party. The other possibility might be that they cover wls, but not lap band. I have heard of insurances picking and choosing which ones they will cover.

I could be wrong, but my understanding of the mandate was it was ONLY a mandate on state offered insurances for Medicaid recipients and employees of the State of Indiana (including individual county and city employees). It is NOT for all insurances offered in Indiana because more then likely those insurances adhere to the rules and regulations where their corporate offices are held at. If you have an insurance where the company is based (corporately) in Indiana, then yes they'd have to include wls options as the state says it's mandated... but if you have say BCBS and it's based in Illinois or Ohio, then no it's not mandated. I could be wrong, but I believe that's how it's working & if I am wrong I'll surely come back and edit this with info to help you out if I can. 

 

Good Luck

Jodi

EDIT: Found this article on the web.

Insurers that issue group accidental and sickness insurance policies and HMOs that provide coverage for basic health care services under a group contract must offer coverage for non-experimental surgical treatment by a health care provider of morbid obesity (1) that has persisted for at least five years and (2) for which non-surgical treatment supervised by a physician has been unsuccessful for at least 18 consecutive months.

Morbid obesity is a weight that is at least two times the ideal weight for frame, age, height, and gender as specified in the 1983 Metropolitan Life Insurance tables. Morbid obesity also means a BMI equal to or greater than 35 kilograms per meter squared with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes or a BMI of 40 kilograms per meter squared without such comorbidity. BMI equals weight in kilograms divided by height in meters squared (Ind. Code § 27-8-14. 1 and § 27-13-7-14. 5)

EDIT: I also found this statement on a few wls centers sites in Indiana

Indiana law only requires that insurance companies that do provide coverage for bariatric surgery mandate no more than a six-month waiting period before a surgery. This waiting period typically requires physician monitoring of the patient’s weight loss attempts.

All insurance companies that provide reimbursement for bariatric surgery must only require that the patients have a BMI of 35 with co-morbidities and a BMI of 40 without co-morbidities.  

Patients should be encouraged to contact their insurances to see whether their plans will cover bariatric surgery.

Linda,
Im not sure how I can find that information out...I know that cooprate is in MO, a state without a mandate.  I have called them and cant get anywhere. It seems as though they have to say no to everything. humph.

Jodi, if you read the posts that you added, the first one basically says they do. and the second one say no they dont. thats where Im getting conflicting information from. IS there a mandate? what is it exactly? You would think that the insurences know about it and adhere to it without a person having to look for the loop holes.  I have a few phone calls to make about it today but I am almost certian I will be hitting my head by the end of the day!

sweetie..
there IS a mandate for indiana
i found a copy of it on indiana.gov
you might wanna check it out

Can you tell me the link or what to search for on the in.gov site, I have searched and could not find it.

I can't find it either on IN.gov.  It burns me up that if I quit my full-time job, Medicaid will pay.

well....it also depends what state your insurance company is BASED in....
i had pekin life outta illinois and illinois has a mandate that ALLOWED the surgery even tho the company i worked for opted out of taking that type of coverage....
i also discussed it with heather at dr jones' office and she did most of the legwork to get it going....
did you mention the indiana mandate to your insurance company???

i called for the second time after I talked to the bariatric center in Caramel. my employer has opted out of all bariatric coverage. .

Tickle...im not sure what state my insurance Co is based out of. MO i would assume. I dont even know how to find out, i guess i will have to call again.

I did find out though that I have indiana hoosier healthwise (medicaid i think) I thought that I only add my children, but Im getting announcements too. To my understanding they cover it but its verry strict. hmm. I will have to wait to get my cards. Its been 3 months...hmm.

How would I find out if my company has a self insured plan?  They employ around 400 people