Anyone work for Harford County ?

My sister (morbidly obese) works for Harford County Public Schools and her insurance won't cover WLS. I understood that in MD, they HAVE to cover you unless there are fewer than 50 employees. Anyone have any experience or help here? thanks

Nancy, Many of the health insurance plans that are provided through public school systems are either through the relevant employee unions or local government, and often are considered self-insured -- that is, the employer (or union) is the insurer, and the health insurance company is acting as an out-sourced administrator of the plan only. Self-insured health plans are "creatures" of the Federal ERISA laws and, as a result, are not under the jurisdiction of the Maryland Insurance Administration, regardless of the size of the employer. The inclusion of WLS is strictly up to the employer/union, and whether it wants it included in the plan; this doesn't mean using a separate rider policy, either. In fact, many of the hospitals in which WLS is performed (and promoted) provide health insurance as part of a self-insured plan, and have chosen to exclude WLS (or only provide it as a special exception or after a drawn out appeal process). Leesa

Nancy, The best thing your sister can do right now it contact her insurance company. Call, write, or email them, specifically ask for their exclusions, if any, for weight loss surgery. They will quote a very generalized statement from their manual. I suggest email so you can get a written response. Get it in writing because when they cover WLS, their written statement often gives specific requirements for approval. There really is not a general answer to the question. It's all based on an individual cir****tances and how many employees often does not override the mandate MD has or the company providing the insurance. Good luck to your sister!