Obamacare and WLS, Which States are Covered

Me, too, and even that 20% is AFTER I meet my deductible...

Fortunately there is an out-of-pocket maximum per year.  That is the biggest reason I had my second knee replacement done in November of the same year that I had the first one done in March.  I had already met the OOP max with the first knee surgery and kidney stone treatment, so every bit of the second knee replacement (other than the prescriptions) was at no cost to me.

The good thing is that you will get a good sized tax credit for having insurance but it will probably be a drop in the bucket compared to medical costs... The docs get you there but they are necessary...

What tax credit?!?  There is no tax credit just for having insurance...

Yeah I am paying for the lowest cost Obama care which I pay $34 a month because of the tax break. So like I said it is cheaper than what you could feed a family of four at McDonalds... each month... And the irony is my deductible is the same as when I had private insurance which I will never meet unless I am in an accident... My present health has me in a state where I won't need a doctor any time soon... Maybe just a checkup...

Other than in states that mandate coverage of WLS, it is usually based on how much you want to pay for a policy.  Chances are, none of the bronze or silver plans are going to cover WLS because the pre-admission testing, surgery, followup care, and complication costs for the first several years are so high... but a platinum plan, which is going to cost a whole lot more in monthly premiums, may cover it. There is no guarantee that any individual plan is going to cover it, though, since it was very difficult before Obamacare to find an individual plan that offered it.  Most people who have insurance paid WLS are in a group plan.

Lora

I have already checked the platinum plans they don't cover it either here is Texas... You would have to go through private insurance in order to get WLS here and I believe it is the same in Mississippi...

My memory is fuzzy, but I think I recall a political battle in Colorado where they decided to not pay for weight loss surgery because there was so much failure due to non-compliance.  Does anybody else remember that debate?

I do remember hearing about such a debate, but I cannot remember what state it was. 

I have seen a couple of articles in various publications in the surgeon's office kitchen/lounge about insurance plans dropping their WLS coverage because many of the people experience significant regain (and continue to have health issues) and/or have complications within the typical 3-year insurance "window" (the average time that people have a particular plan) and therefore the companies are not seeing the "return on investment" that they expect/want.

Yes I agree it is always the downside to this issue... There are many who fail to keep the weight off and it makes it look like the surgery does not have a high success rates... However its not good that they do not look at ones like you and I who have had great successes and can now live healthy lives... It seems to me that would be evidence to do some analytics on WLS to be able to find the perfect match for surgery. Then it would be a case by case study as to who was approved... I believe that because I had so many health problems before surgery and was in and out of the doctors so much that my insurance company approved me for surgery using that basis along with as you said the extent of time I had been paying on my insurance. Still there is no magic bullet in WLS it does take work to keep the tool in it's optimized state... You made a great point thanks for replying...

I had my surgery in Colorado, and as far as I can remember every person that got WLS when I did had great success with it where it seemed like 100% success rate... but that was just from one geographical area I am sure it is different throughout Colorado, and that is not even counting all the failed lap bands as well, so the insurance companies are probably viewing those and making their decisions on that basis...