Have a tentative date. :)

I had my consultation yesterday, and today I set an appointment for August 15th. w00t! I am having my husband check into his insurance ONE MORE time. I hope the HR guy gets back to us quick, as if I'm going self-pay I need to get things on the ball next week ASAP. I have been reading up on people's experiences with UHC... and in cases where they approve the procedure at all, they seem to be pretty easy and quick. I'm not getting my hopes up, though, since the MD laws cover only "large groups". Was that a decision by MD to let small companies out of it, or are small companies just automatically bound only to the feds by virtue of their size.

Vicky, Congratulations on getting a date. It will be here before you know it. In response to your question(s) about the insurance, the small group exemption in Maryland has nothing to do with the Federal government or Federal control. The state has small group health plans regulated through the Maryland Health Care Commission (MHCC), which is tasked to develop a standard comprehensive benefit plan which all insurance companies offering health plans to the small market must provide as a standard package. By state law, the premiums for these health insurance plans can be no more than (I believe) 10% of the "average annual wage" for the Maryland worker, a figure which changes from year to year, but which caps the premium. As a result, the MHCC is able to pick and choose from certain coverages which otherwise must be included in the large group plans; one of these is WLS. Not that I'm making excuses for the MHCC, but I understand there are many other types of health care coverage which they have to pick and choose from to include or exclude from the standard comprehensive benefit plan. Where the Federal law comes into play is in connection with the self-funded health insurance plans, which are a "creature" of the Federal ERISA laws. In the case of the self-funded health insurance plans -- which often are found in very large corporate/business organizations -- the State of Maryland really has no jurisdiction at all; that is, the State can neither require, nor exempt inclusion of WLS from those plans. It is entirely up to the employer, which ultimately is the insurer and where the health insurance company is acting as the administrator of the plan for the insurer/employer. Anyway, good luck in your final preparations for WLS. Leesa

Thanks for the info. Initially I was completely skeptic about any company choosing to pay for WLS if not forced. That train of thought was born from the many thin people who seem to think WLS is for losers who just need to do situps. When I learned that MD had laws, found this website, and saw all the people managing to get coverage, my attitude changed significantly. My husband's employer uses UHC. I went to UHC's website and there were categories it couuuuld fit under if you bent it and stretched it, but there was nothing definitive. I called UHC and go a flat out NO. When I learned that I could not apply the MD laws to companies under 50 (therefore having no real legal standing) I started to get discouraged. I then turned to my own company's insurance. Cigna. Cigna's website was the same way. I called Cigna... got a "no". I had HR lady #1 call Cigna... got a "no". Had HR lady #2 call Cigna... got a "no". (Oh, but they will cover a nutritionist.) My company is in D.C. It didn't seem like appealing would be any good in either case, since it was flat out not covered at all. It wasn't like it was covered except that I didn't meet qualfications or something. Well, when I realized I could take a loan against my 401K I was pretty happy. Hate having to do that, but I won't mess with second mortgages and didn't want sky high interest rates. I was actually looking over the paperwork today, but thought I may as well have the Dr. office submit to UHC for kicks. What's the worst they can do but say no again. The only other angle I hadn't tried was having my husband talk to his HR guy. I had him forward an email a couple days ago, but he was out of town. Apparently, *today* he told my husband that I shouldn't have any problem. (?!?!) He contacted someone and is waiting to hear back. Whether he knows this for a fact or has seen it occur, I have no idea. He might just be an open minded dude who thinks "Hunh. Why wouldn't it be covered." Sooo, I'm hopeful while not holding my breath. If HR guy says go for it, I can only hope they will keep my surgery date reserved while I await approval. I'm not sure how that typically works, but it doesn't feel like UHC takes very long in situations where they approve WLS. Thanks for the info and well wishes. It really is a roller coaster ride! The whole thing is so surreal already. Having it paid for would be the icing on the cake [made with Splenda.]

Depending on which department and person I spoke with at BC/BS Carefirst I would get multiple answers. Customer Service didn't speak to Case Management and Case Management didn't speak to Utilization Review. Even my HR department had some mixed info. I really was given the run around when I first started to investigate. Insurances do not like to pay for this expensive surgery. That is just a fact!!!!! Then I found the policy online about morbid obesity as well as finally someone who actually knew what they were talking about. Once I switched to Dr. Kligman from Dr. Schweitzer(he was not credentialed with BC/BS for my policy), I was covered. I am suppose to be covered at 100% although I've got over a 3k bill now from University of MD so now I have to clear that up as well. My HR told me to tell them to resubmit the claim to BC/BS. Ahh.. the fight goes on. I won't pay a cent unless I have to and you should not either. Regardless of what your HR guy says I would still submit and see what happens. Worse case scenario you get denied and then you self pay.