WLS insurance coverage in Virginia

I live in Maryland and there is a law if ones employer has more than 50 employees- the WLS (Gastric bypass anyway) must be a covered benefit. Is there any such law in Virginia? Or- what resources or steps should one take to try to get it covered by health insurance if in Virginia? My sister works for a Virginia County public school system---I think its Loudon County. I am inquiring for some basic information to help her in the process of exploring the WLS options. She is thinking she will have to be self pay and is nearly throwing in the towel and giving up that WLS is even an option for her. Any information or advice is appreciated. Thanks Karen

Sorry, no such law here. The only law on the books pertain to "riders". All insurance companies have to offer "riders" for certain procedures to companies that chose their insurance. The insurance company cannot deny coverage if the Employer pays for the "Rider" for the procedure. Employers can opt out and not pay for it. So, really it's not the insurance company who dictates what is covered, it's the employer. Some can't afford to purchase the riders, os they don't in order to keep costs down for employees who choose their insurance. It can't hurt for her to get a copy of her insurance policy with all written exclusions. Wording is very important too. there are loopholes, I know because I found one and got my insurance to pay for my RNY.

I'm so glad someone asked this question. I'm struggling to find a way to have surgery covered through my Insurance which states that the will not covere any type of weight loss surgery

I work at Fort Lee VA for CSC but am a School Board member in my locality. Its not much of an answer to your question but, my experince working as a contractor that changes insurance coverages every few years and what we offer our teaching staff and administration in the school system,..it really depends on how good (or lousey) your insurance providers coverage is, the policy the employer is willing to make available in theri efforts to control premium costs. I've have Lincoln National (didn't cover WLS), Aetna (did, then didn't then particle coverage, then did (so I got it this last time)), Cigna (didn't now they do but its hard to get approved, usually required being denied twice first). Its a real head game. I went to our Aetna provider coverage website and printed the policy, then called for advice on waht I was understanding, stated my condition and asked for their recommendation. Hoghlighted the requiremetnst and made an outline of the order things needed to be doen and what needed to happen and be submitted. It took some effort and followup on my part, and irritated at least one front office person at muy primary care physican, but I got approved on my first effort. I got record from previous doctors that required three attempts and followups. I got my records from the sleep apnea doctor and my cardiologist, and I had an appointment where me and the physician did nothing but fill out the six month paper work for the medically supervised weightloss and exercise requirement (using my record of visits and weights compared to his records on me). I even wote the doctor recommendation letter to insurance and had him read it, copyit to his letterhead, and after agreeing, he signed it and I mailed it to insurance to make it happen in a timely fashion with the efforts of the WLS surgeons timetable. Pushy but it worked. Good luck. Hope your sister appreciates your assistance. Joe

I work for Fairfax County Public Schools, and I took the job in order to be covered for WLS......other than that, I apologize, I am of no help, other than I know FFX pays for it... Good luck! Dianna