New TN law to cover WLS beginning JANUARY 2006!!!!!

OMG OMG OMG!!! I just found info on a new law that was passed requiring ALL insurance companies to COVER bariatric surgery for the treatment of morbid obesity beginning January 1, 2006!!! This is what I found as listed on the TN General Assembly's website, (http://www)legislature.state.tn.us/ I copied and pasted most of it but not all of it. To read all of it, go to their website and plug in either Senate Bill 786 (SB0786) or House Bill 90 (HB0090): Here it is: "Notwithstanding any other provision of law to the contrary, any individual, franchise, blanket, or group health insurance policy, medical service plan contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society, health maintenance organization, preferred provider organization, or managed care organization which provides hospital, surgical, or medical expense insurance shall offer and make available coverage under any such policy, contract, or plan for bariatric surgery for the treatment of morbid obesity." "The provisions of this section are applicable to all health benefit policies, programs, or contracts which are offered by commercial insurance companies, nonprofit insurance companies, health maintenance organizations, preferred provider organizations, and managed care organizations, and which are entered into, delivered, issued for delivery, amended, or renewed after January 1, 2006." "Reimbursement for the treatment of morbid obesity by bariatric surgery shall be determined according to the same formula by which charges are developed for other medical and surgical procedures. Such coverage shall have durational limits, dollar limits, deductibles, copayments, and coinsurance factors that are no less favorable than for other types of major surgery for treatment of physical illness or disease generally. Standards and criteria, including those related to diet, used by insurers to approve or restrict access to bariatric surgery for morbid obesity shall be based upon current clinical guidelines recognized by the National Institutes of Health. Those standards may include the requirement that an insured document that physician supervised weight control treatment has been ineffective in reducing the insured's weight below the levels articulated for morbid obesity, whether or not the policy, contract, or plan provides coverage for physician supervised weight control treatment. The surgeons contracted by the insurers to provide bariatric surgery for morbid obesity shall have current experience in bariatric surgery and shall meet the standards set forth by the American Society of Bariatric Surgery and the National Institutes of Health, if any." "SECTION 2. This act shall take effect on January 1, 2006, the public welfare requiring it." I am sooooo HAPPY!!! What do y'all think about this? Do you think our prayers have finally been heard? I hope I am not interpreting this wrong and getting my hopes up for nothing. I may post this on the insurance board and maybe one of the lawyers will respond. If this is really going to take effect in January 2006, I am going to get all my ducks in a row now, i.e. get started on a medically supervised weight loss plan (cuz u know the insurance company will probably require that) and start the insurance process now so that come January (if I am in the appeal process) they will have to approve instead of just beginning the process at that point? What do y'all think about that or do you think I am jumping the gun? I was so ready for weight loss surgery yesterday, last week, last year, lol... CONGRATULATONS to ALL of US, we DESERVE this!!!!! Tammy

Tammy, I hate to burst your bubble, but these bills, SB0786 & HB0090 are going through the house and senate, they have not been approved yet. We can only HOPE they will be passed. Pam

REALLY????? If that's true, that really sucks. How can we check the status on these bills to know if and when they will be approved? Well at least we know that the state of TN is trying to do something. Please respond. Thanks, Tammy

TAMMY, JUST KEEP CHECKING THAT WEB SITE. IT IS UPDATED THE WHOLE TIME THEY ARE IN SESSION. THEY WILL PROBABLY BE GOING OUT OF SESSION AROUND THE END OF THIS MONTH OR SOMETIME NEXT MONTH IF IT PASSES THE SITE SHOULD INDICATE THAT.. LETS HOPE...

Thanks! I just checked again and read some more information about the process and as far as I can tell, it has passed the 1st and 2nd considerations in both the House and the Senate, now I believe we only need it to pass one more time (still not 100% sure on how the process works, on how a bill becomes a law, man I wished I had paid more attention in Political Science class! lol) ... anyways, keep your fingers crossed. I hope I am right about this. If anyone out there knows how this process works, please enlighten me! Tammy

I think how we can all help, is to write/e-mail our reps and request they support this bill. As soon as I heard about it last year, I requested our CEO write a letter requesting support from our reps. The more volume of letters/e-mails they get, the more support we provide. Also-I don't think they need a whole life history, but postop. patients with good outcomes that are off many medications should let them know that too. Pam

Pam, I agree with you 110%..!! I just don't know where to even start with a Letter! Someone out there got me I can go by? Help Me Please!

If I am reading this right it will only apply to private insurances and not to the Tenncare program or Medicare

I'm sorry but I think you're right. However, I know of several people with TN Care that have had the surgery approved. What you need to do is call the 800 number on the back of your card and request a case manager be assigned to you to help you apply for WLS and they will walk you through the process and advocate for you. Good luck!!! Don't EVER give up! Tammy

Hi Tammy: I have been reading a lot about the bariatric surgery and finally decided to check into the procedures. Everyone where I work was telling me of other people in our organization that had been through the surgery, doing well with it; and the insurance company paid for it. WELL, I went to a meeting to start the process, called my insurance company today and found out this surgery is excluded on my policy. When I called my HR department, there is a plan that was offered to all employees back in open enrollment that covered the surgery but I chose BCBS and that policy excludes this surgery. What a bummer! I was reading the message board and happened across your note. Is this law for real? Did you check further on this? I asked my HR department about this and they said if TN had this law, then they would have to cover the surgery. I'm really wanting to proceed with this, so much, that if I don't have a possibility of insurance covering it, I am considering making a loan to pay for this. I am so tired of living in this "body of fat" that I want the real me to be able to live life without all the side effects of the fat. I am so depressed right now cause my hopes were brought up and then bashed on the ground today. My HR department told me that our new 2006 benefits package would be coming out in September and she suggested that I wait until then and call her back to see if any of the policies will be covering this surgery. I have waited all my life and I guess a few more months won't matter but I sure am pretty depressed right now.....It would be so wonderful to hear that this is really true and we are not going to be discriminated against because of our condition. Any information you can share would be wonderful Sandy