New Job new insurance - Care First of MD
Hello. Ive accepted an offer to work for a new employer and they have Care First (Blue Cross Blue Shield) of Maryland. A quick search in the Insurance by State section, looks like care first will cover some procedures. Does anyone know about this insurance and their policies or ryders the company has to buy to be covered? My new company has offered to buy ANY insurance extra policy I require for my family. So I'm trying to find out what =it is for bariatric surgury.
Thanks.
Thanks.
Hi Jack!!
Insurance is such a tricky thing, and I'm sure you could talk to 10 people and get 10 different answers.
I saw on your profile that you're interested in having surgery at JHH - I guarantee you that the surgeon's office has an insurance coordinator who (hopefully) should be able to give you some direction.
I'm sorry I couldn't be of more help! Good luck on your journey!
Tia
I have Carefirst of MD and had it when I had my surgery. However, that was 21 months ago. My employer did not cover it when they were considered a small company (less than 50 employees), but they did cover my RNY once we had over 50 employees. I do not know about the other procedures. Tia's advice is probably best. Good luck to you!
Hi Jack:
Welcome to the board. Below is a copy of Maryland State law Senate Bill 522: I hope this of some use to you. Good luck and I hope it all works in your favor.
SENATE BILL 522 Unofficial Copy 2001 Regular Session C3 1lr0385 SB 496/00 - FIN CF 1lr0386 ____________________________________________________________________________________ By: Senators Hoffman and Hollinger, Hollinger, Bromwell, Dorman, Astle, DeGrange, Della, Exum, Hafer, Hooper, Kelley, Roesser, and Teitelbaum Introduced and read first time: February 2, 2001 Assigned to: Finance _____________________________________________________________________________________ Committee Report: Favorable with amendments Senate action: Adopted Read second time: March 21, 2001 _____________________________________________________________________________________ CHAPTER_______ 1 AN ACT concerning 2 Health Insurance - Treatment of Morbid Obesity 3 FOR the purpose of requiring certain insurers, nonprofit health service plans, health 4 maintenance organizations, and managed care organizations, and carriers to 5 provide coverage for the expenses incurred by certain obese patients for certain 6 surgical treatment under certain cir****tances; authorizing certain benefits to 7 be provided through a managed care system; of morbid obesity; requiring the 8 coverage of morbid obesity to be provided to the same extent as for other 9 medically necessary surgical procedures; defining certain terms; providing for 10 the application of this Act; and generally relating to coverage of expenses for 11 surgical treatment of morbid obesity under health insurance. 12 BY adding to 13 Article - Insurance 14 Section 15-837 15 Annotated Code of Maryland 16 (1997 Volume and 2000 Supplement) 17 BY adding to 18 Article - Health - General 19 Section 19-706(rr) 20 Annotated Code of Maryland 21 (2000 Replacement Volume) 2 SENATE BILL 522 1 Preamble 2 WHEREAS, Obesity is a significant health problem affecting hundreds of 3 thousands of Maryland residents; and 4 WHEREAS, Severe or morbid obesity increases the mortality rate more than 5 threefold, causes physical and emotional disability, is often associated with comorbid 6 conditions compounding its adverse impact on longevity and quality of life, and is 7 amenable to established surgical treatment; and 8 WHEREAS, Like other chronic diseases, obesity is caused or aggravated by 9 many factors including genetics, behavior, metabolism, and environment, certain 10 therapeutic interventions can alter its course and severity, and therefore, obesity 11 should be treated for purposes of insurance like other medical conditions; and 12 WHEREAS, Health insurance policies commonly exclude coverage for the 13 treatment of obesity, even when severe or morbid and complicated by comorbid 14 conditions; now, therefore, 15 SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF 16 MARYLAND, That the Laws of Maryland read as follows: 17 Article - Insurance 18 15-837. 19 (A) (1) IN THIS SECTION THE FOLLOWING WORDS HAVE THE MEANINGS 20 INDICATED. 21 (2) "BODY MASS INDEX" MEANS A PRACTICAL MARKER THAT IS USED TO 22 ASSESS THE DEGREE OF OBESITY AND IS CALCULATED BY DIVIDING THE WEIGHT IN 23 KILOGRAMS BY THE HEIGHT IN METERS SQUARED. 24 (3) "MANAGED CARE SYSTEM" MEANS A METHOD THAT AN INSURER, 25 NONPROFIT HEALTH SERVICE PLAN, OR HEALTH MAINTENANCE ORGANIZATION 26 USES TO REVIEW AND PREAUTHORIZE A TREATMENT PLAN THAT A HEALTH CARE 27 PRACTITIONER DEVELOPS FOR A COVERED PERSON USING A VARIETY OF COST 28 CONTAINMENT METHODS TO CONTROL UTILIZATION, QUALITY, AND CLAIMS. 29 (4) (3) "MORBID OBESITY" MEANS A BODY MASS INDEX THAT IS: 30 (I) GREATER THAN 40 KILOGRAMS PER METER SQUARED; OR 31 (II) EQUAL TO OR GREATER THAN 35 KILOGRAMS PER METER 32 SQUARED WITH COMORBIDITY OR COEXISTING MEDICAL CONDITIONS, INCLUDING 33 HYPERTENSION, CARDIOPULMONARY CONDITIONS, SLEEP APNEA, OR DIABETES. 34 (B) THIS SECTION APPLIES TO: 3 SENATE BILL 522 1 (1) INSURERS AND NONPROFIT HEALTH SERVICE PLANS THAT PROVIDE 2 HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GROUPS ON AN 3 EXPENSE-INCURRED BASIS UNDER HEALTH INSURANCE POLICIES OR CONTRACTS 4 THAT ARE ISSUED OR DELIVERED IN THE STATE; AND 5 (2) HEALTH MAINTENANCE ORGANIZATIONS THAT PROVIDE HOSPITAL, 6 MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GROUPS UNDER CONTRACTS 7 THAT ARE ISSUED OR DELIVERED IN THE STATE; AND 8 (3) MANAGED CARE ORGANIZATIONS, AS DEFINED IN § 15-101 OF THE 9 HEALTH - GENERAL ARTICLE; AND 10 (4) CARRIERS THAT OFFER HEALTH BENEFIT PLANS UNDER TITLE 15, 11 SUBTITLE 12 OF THE INSURANCE ARTICLE. 12 (C) SUBJECT TO SUBSECTION (E) OF THIS SECTION, AN ENTITY SUBJECT TO 13 THIS SECTION SHALL PROVIDE COVERAGE FOR THE EXPENSES INCURRED BY A 14 PATIENT WITH MORBID OBESITY FOR ESTABLISHED SURGICAL TREATMENT IF: 15 TREATMENT OF MORBID OBESITY THROUGH GASTRIC BYPASS SURGERY OR 16 ANOTHER SURGICAL METHOD THAT IS: 17 (1) RECOGNIZED BY THE NATIONAL INSTITUTES OF HEALTH AS 18 EFFECTIVE FOR THE LONG-TERM REVERSAL OF MORBID OBESITY; AND 19 (2) CONSISTENT WITH CRITERIA APPROVED BY THE NATIONAL 20 INSTITUTES OF HEALTH. 21 (1) ALL NONSURGICAL MEDICAL THERAPIES, AS DETERMINED BY THE 22 PHYSICIAN, HAVE FAILED; AND 23 (2) THE BODY MASS INDEX OF THE PATIENT EXCEEDS: 24 (I) 40 KILOGRAMS PER METER SQUARED; OR 25 (II) 35 KILOGRAMS PER METER SQUARED IN THE PRESENCE OF 26 HYPERTENSION, DIABETES, HIGH LDL CHOLESTEROL, LOW HDL CHOLESTEROL, 27 HYPERTRIGLYCERIDEMIA, SLEEP-APNEA SYNDROME, OSTEOARTHRITIS, OR OTHER 28 MEDICAL CONDITIONS CONSIDERED BY A PHYSICIAN POTENTIALLY REMEDIABLE BY 29 SIGNIFICANT WEIGHT REDUCTION. 30 (D) AN ENTITY SUBJECT TO THIS SECTION SHALL PROVIDE THE BENEFITS 31 REQUIRED UNDER THIS SECTION TO THE SAME EXTENT AS FOR ANY OTHER 32 MEDICAL CONDITION MEDICALLY NECESSARY SURGICAL PROCEDURES UNDER THE 33 ENROLLEE'S OR INSURED'S CONTRACT OR POLICY WITH THE ENTITY. 34 (E) AN ENTITY SUBJECT TO THIS SECTION MAY PROVIDE THE BENEFITS 35 REQUIRED UNDER THIS SECTION THROUGH A MANAGED CARE SYSTEM. 4 SENATE BILL 522 1 Article - Health - General 2 19-706. 3 (RR) THE PROVISIONS OF § 15-837 OF THE INSURANCE ARTICLE APPLY TO 4 HEALTH MAINTENANCE ORGANIZATIONS. 5 SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 6 policies, contracts, and health benefit plans issued, delivered, or renewed in the State 7 on or after October 1, 2001. 8 SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 9 October 1, 2001. SENATE BILL 522 Unofficial Copy 2001 Regular Session C3 1lr0385 SB 496/00 - FIN CF 1lr0386 ____________________________________________________________________________________
Welcome to the board. Below is a copy of Maryland State law Senate Bill 522: I hope this of some use to you. Good luck and I hope it all works in your favor.
SENATE BILL 522 Unofficial Copy 2001 Regular Session C3 1lr0385 SB 496/00 - FIN CF 1lr0386 ____________________________________________________________________________________ By: Senators Hoffman and Hollinger, Hollinger, Bromwell, Dorman, Astle, DeGrange, Della, Exum, Hafer, Hooper, Kelley, Roesser, and Teitelbaum Introduced and read first time: February 2, 2001 Assigned to: Finance _____________________________________________________________________________________ Committee Report: Favorable with amendments Senate action: Adopted Read second time: March 21, 2001 _____________________________________________________________________________________ CHAPTER_______ 1 AN ACT concerning 2 Health Insurance - Treatment of Morbid Obesity 3 FOR the purpose of requiring certain insurers, nonprofit health service plans, health 4 maintenance organizations, and managed care organizations, and carriers to 5 provide coverage for the expenses incurred by certain obese patients for certain 6 surgical treatment under certain cir****tances; authorizing certain benefits to 7 be provided through a managed care system; of morbid obesity; requiring the 8 coverage of morbid obesity to be provided to the same extent as for other 9 medically necessary surgical procedures; defining certain terms; providing for 10 the application of this Act; and generally relating to coverage of expenses for 11 surgical treatment of morbid obesity under health insurance. 12 BY adding to 13 Article - Insurance 14 Section 15-837 15 Annotated Code of Maryland 16 (1997 Volume and 2000 Supplement) 17 BY adding to 18 Article - Health - General 19 Section 19-706(rr) 20 Annotated Code of Maryland 21 (2000 Replacement Volume) 2 SENATE BILL 522 1 Preamble 2 WHEREAS, Obesity is a significant health problem affecting hundreds of 3 thousands of Maryland residents; and 4 WHEREAS, Severe or morbid obesity increases the mortality rate more than 5 threefold, causes physical and emotional disability, is often associated with comorbid 6 conditions compounding its adverse impact on longevity and quality of life, and is 7 amenable to established surgical treatment; and 8 WHEREAS, Like other chronic diseases, obesity is caused or aggravated by 9 many factors including genetics, behavior, metabolism, and environment, certain 10 therapeutic interventions can alter its course and severity, and therefore, obesity 11 should be treated for purposes of insurance like other medical conditions; and 12 WHEREAS, Health insurance policies commonly exclude coverage for the 13 treatment of obesity, even when severe or morbid and complicated by comorbid 14 conditions; now, therefore, 15 SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF 16 MARYLAND, That the Laws of Maryland read as follows: 17 Article - Insurance 18 15-837. 19 (A) (1) IN THIS SECTION THE FOLLOWING WORDS HAVE THE MEANINGS 20 INDICATED. 21 (2) "BODY MASS INDEX" MEANS A PRACTICAL MARKER THAT IS USED TO 22 ASSESS THE DEGREE OF OBESITY AND IS CALCULATED BY DIVIDING THE WEIGHT IN 23 KILOGRAMS BY THE HEIGHT IN METERS SQUARED. 24 (3) "MANAGED CARE SYSTEM" MEANS A METHOD THAT AN INSURER, 25 NONPROFIT HEALTH SERVICE PLAN, OR HEALTH MAINTENANCE ORGANIZATION 26 USES TO REVIEW AND PREAUTHORIZE A TREATMENT PLAN THAT A HEALTH CARE 27 PRACTITIONER DEVELOPS FOR A COVERED PERSON USING A VARIETY OF COST 28 CONTAINMENT METHODS TO CONTROL UTILIZATION, QUALITY, AND CLAIMS. 29 (4) (3) "MORBID OBESITY" MEANS A BODY MASS INDEX THAT IS: 30 (I) GREATER THAN 40 KILOGRAMS PER METER SQUARED; OR 31 (II) EQUAL TO OR GREATER THAN 35 KILOGRAMS PER METER 32 SQUARED WITH COMORBIDITY OR COEXISTING MEDICAL CONDITIONS, INCLUDING 33 HYPERTENSION, CARDIOPULMONARY CONDITIONS, SLEEP APNEA, OR DIABETES. 34 (B) THIS SECTION APPLIES TO: 3 SENATE BILL 522 1 (1) INSURERS AND NONPROFIT HEALTH SERVICE PLANS THAT PROVIDE 2 HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GROUPS ON AN 3 EXPENSE-INCURRED BASIS UNDER HEALTH INSURANCE POLICIES OR CONTRACTS 4 THAT ARE ISSUED OR DELIVERED IN THE STATE; AND 5 (2) HEALTH MAINTENANCE ORGANIZATIONS THAT PROVIDE HOSPITAL, 6 MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GROUPS UNDER CONTRACTS 7 THAT ARE ISSUED OR DELIVERED IN THE STATE; AND 8 (3) MANAGED CARE ORGANIZATIONS, AS DEFINED IN § 15-101 OF THE 9 HEALTH - GENERAL ARTICLE; AND 10 (4) CARRIERS THAT OFFER HEALTH BENEFIT PLANS UNDER TITLE 15, 11 SUBTITLE 12 OF THE INSURANCE ARTICLE. 12 (C) SUBJECT TO SUBSECTION (E) OF THIS SECTION, AN ENTITY SUBJECT TO 13 THIS SECTION SHALL PROVIDE COVERAGE FOR THE EXPENSES INCURRED BY A 14 PATIENT WITH MORBID OBESITY FOR ESTABLISHED SURGICAL TREATMENT IF: 15 TREATMENT OF MORBID OBESITY THROUGH GASTRIC BYPASS SURGERY OR 16 ANOTHER SURGICAL METHOD THAT IS: 17 (1) RECOGNIZED BY THE NATIONAL INSTITUTES OF HEALTH AS 18 EFFECTIVE FOR THE LONG-TERM REVERSAL OF MORBID OBESITY; AND 19 (2) CONSISTENT WITH CRITERIA APPROVED BY THE NATIONAL 20 INSTITUTES OF HEALTH. 21 (1) ALL NONSURGICAL MEDICAL THERAPIES, AS DETERMINED BY THE 22 PHYSICIAN, HAVE FAILED; AND 23 (2) THE BODY MASS INDEX OF THE PATIENT EXCEEDS: 24 (I) 40 KILOGRAMS PER METER SQUARED; OR 25 (II) 35 KILOGRAMS PER METER SQUARED IN THE PRESENCE OF 26 HYPERTENSION, DIABETES, HIGH LDL CHOLESTEROL, LOW HDL CHOLESTEROL, 27 HYPERTRIGLYCERIDEMIA, SLEEP-APNEA SYNDROME, OSTEOARTHRITIS, OR OTHER 28 MEDICAL CONDITIONS CONSIDERED BY A PHYSICIAN POTENTIALLY REMEDIABLE BY 29 SIGNIFICANT WEIGHT REDUCTION. 30 (D) AN ENTITY SUBJECT TO THIS SECTION SHALL PROVIDE THE BENEFITS 31 REQUIRED UNDER THIS SECTION TO THE SAME EXTENT AS FOR ANY OTHER 32 MEDICAL CONDITION MEDICALLY NECESSARY SURGICAL PROCEDURES UNDER THE 33 ENROLLEE'S OR INSURED'S CONTRACT OR POLICY WITH THE ENTITY. 34 (E) AN ENTITY SUBJECT TO THIS SECTION MAY PROVIDE THE BENEFITS 35 REQUIRED UNDER THIS SECTION THROUGH A MANAGED CARE SYSTEM. 4 SENATE BILL 522 1 Article - Health - General 2 19-706. 3 (RR) THE PROVISIONS OF § 15-837 OF THE INSURANCE ARTICLE APPLY TO 4 HEALTH MAINTENANCE ORGANIZATIONS. 5 SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 6 policies, contracts, and health benefit plans issued, delivered, or renewed in the State 7 on or after October 1, 2001. 8 SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 9 October 1, 2001. SENATE BILL 522 Unofficial Copy 2001 Regular Session C3 1lr0385 SB 496/00 - FIN CF 1lr0386 ____________________________________________________________________________________
never settle for less than you deserve and you deserve only the best. 
Most Active
Recent Topics
