Health Insurance Issues

I have coventry of DE. We are a small group in maryland and i have been told that because I am a small group that WLS is not covered and because I am in a small group we (the ins company says) i could not afford the premiums for the coverage. However, my question is isnt it state law for Maryland (where I am a resident and where our coverage is purchased through) that if it is medically necessary the must provide coverage for the WLS? And does Maryland law say if you are a small group are they allowed to deny me coverage even if it is medically necessary?

Kelli, Currently the law exempts small business with 50 or less people. You might want to try to appeal with the Md. Insurance Commissioners Office though I have heard from some people the legislature may attempt to change the regulation but that wouldn't be until next year. The commissioner's website is: http://www.mdinsurance.state.md.us/ I had the same problem since I am self-employed with a small group policy. If you own a home, you might want to consider taking out some equity to pay for the surgery (which is tax deductible according to my accounant) and then pay yourself back. Though the hospital wanted a lot of money upfront ($14700), I got a refund of over $5000. Good luck! Brynn

Actually, the Maryland State mandate is that ALL insurance companies must offer coverage for WLS. In other words, some insurance companies never had ANY coverage for WLS, so they were all required to create that as part of their offered policies to employers. The actual mandate is to the insurance companies, not to employers. So it does not exempt small group employers from being able to purchase the policies, however smaller group employers typically don't purchase the policies including WLS coverage for their employees because it costs more. The insurance companies are following the mandate and offering the coverage, but employers (large or small) are not required to purchase these policies for their employees. I know that doesn't really help your situation. But should you decide to seek employment elsewhere, don't be fooled by thinging that you have to stay away from small group employers because it really has nothing to do with it. There are employers with over 50 employees who don't offer a policy with WLS coverage, just as there are several small group employers who do have those policies. Good luck.

Thanks Roni - I am self employeed (so seeking employment elsewhere sometimes sounds like a good idea to me it wont work LOL). When I told my insurer about the mandate when i first talked to them I also told them I was the decision maker of my small group and wanted to know how to go about getting coverage...she told me that it was not offered - because we couldnt afford it. I was so mad - how does she know what i can afford?! Anyway your info helped and I am going to continue this fight. I really want to have the healthy part of my life back! Even if I have to pay myself....I just pay ALOT in premiums and want them to pay if they should!

You are absolutely right, it's not her decision whether or not you can afford the coverage. Did you ask her about adding to or upgrading you current policy to include coverage for WLS??? It might be a beeter idea to shop around for other insurance brokers too. I hope it works out for you soon, Roni