HEALTH INSURANCE

I just came across this forum and I'd like to say hello to my fellow Marylanders.  I am having trouble buying health insurance that covers wls.  I was anxiously waiting for the new one that was recently signed but was told wls is not covered.  I am self employed and a diabetic.  Does anyone know of a good insurance company other than BCBS?  Your help is greatly needed.  KC.

Have you tried Aetna, or Kaiser I know they both cover the procedure , my sister had hers covered thru United Health Care, Aetna definitley covers .B sure to tell them that you want a plan that includes weight loss surgery.

 Actually, it's law in Maryland that WLS surgery is covered by all insurance if you meet the NIH criteria for each surgery (e.g. BMI requirements, comorbidities, 6mo weight loss MD supervised, etc). So if the insurance company policy does not gel with what MD state law is, you can go to the Insurance Board and consult/complain. http://www.mdinsurance.state.md.us/sa/jsp/Mia.jsp

Thank you very much nfarris79.  This is an eye opener for me.  I have called the new Maryland Health Insurance Plan for pre-existing conditions that was signed by President Obama and they told me outrightly that wls will not be covered.  I sure do appreciate this piece of  information. I'll start applying with Kaiser.  Thank you.

 Knowing your rights is a good thing! Keep in mind that the pre-existing conditions clause on the Federal Health Care Reform Bill (see website healthcare.gov for more info on that) has not gone into effect for adults but is in effect for kids. However, since Maryland has a law requiring carriers to provide a certain minimum benefits (see source below), bariatric patients should be covered or would at least have legal grounds to appeal a rejection. I'm not a lawyer but have done a TON of research on making sure this stuff is covered! I have BCBS and have basically memorized their medical policy on WLS. If you ever need to have a source to refer to, I suggest the below source - from COMAR 

31.11.06.03

 (code of Maryland laws). Also looking up the NIH criteria for WLS and being well versed in how you fit (no pun intended!) their criteria, will help you be  the best advocate for your health care. See this site for some helpful info from NIH: http://www.nlm.nih.gov/medlineplus/weightlosssurgery.html

Can't promise you anything on what hoops Kaiser may have you jump thru - as a mental health provider, all I know about Kaiser is that they have their own contracted professionals and are loathe to refer out - but in the end, you can be your own voice to really get the WLS you need to meet your goals. Good luck!!!!

"A-1. Morbid Obesity.

(1) When establishing utilization review criteria for the surgical treatment of morbid obesity, a carrier or a private review agent acting on behalf of a carrier shall adhere to the requirements of COMAR 31.10.33.03.

(2) Surgical treatment of morbid obesity shall occur in a facility that is:

(a) Designated by the American Society for Metabolic and Bariatric Surgery as a Bariatric Surgery Center of Excellence; and

(b) Designated by the carrier.

(3) If a carrier does not make a designation under §A-1(2) of this regulation, the carrier shall provide benefits under the health benefit plan for the surgical treatment of morbid obesity at any facility that is designated by the American Society for Metabolic and Bariatric Surgery as a Bariatric Surgery Center of Excellence."

Thank you very much.  I applied with BCBS last year and was told my BMI is higher that what they accept. I don't think I'll have any luck with Kaiser either because my doctor is in DC and I would like to use him.  So what do you suggest? Should I apply with the Federal Health Care program? Thanks for your great help.

 Ugh! Sounds like a yucky catch-22. BMI too high to be insured but to get the BMI down WLS surgery would be best- but need insurance to get WLS! I"m sorry you're going thru that.
SO is the FHC program a high-risk pool? My understanding is that's a good program for those who have comorbid or high-risk conditions but wouldn't be eligible on the mass market to buy private insurance. I almost always encourage people to see if they qualify for Medicaid, b/c they actually have good coverage & reimburse MDs really well - that's the practitioner in me talking - but if your income is too great (ridiculous phrasing, I know) to qualify for Medicaid, than the FHC is the way to go. BUT always check out what their coverage is before you sign on the line - better to know beforehand than to have insurance that doesn't do what you want it to do! Better to prevent than lament. Again, I always let people know - especially on blogs etc - that I'm not an insurance specialist, lawyer or MD, but have been going thru the process with an eye on my bottom line too. Not just my bottom. ha ha

Good luck in the process & keep the hope that it's all worth it in the end!
- nfarris

Nfarris thanks for your prompt reply.  I called the FHC and was surprised to hear that WLS is not covered.  Also, my income is too high for medicaid.  I might end up enrolling in the FHC and then find a company that does financing.  Thanks again.