Ill Division of Insurance

This is what Illinois Department of Insurance has to say about Morbid Obesity. http://www.ins.state.il.us//Reports/OCHI/OCHI_2003_Annual_Report.htm#1 Morbid Obesity:Many plans deny treatment for morbid obesity on the basis the treatment is cosmetic in nature or experimental and investigational. The number of overweight and obese Americans has continued to increase and with this increase the Department has received complaints requesting payment for weight reduction treatment, including gastric bypass surgery. The complaints have included documentation from providers indicating the medical necessity of the procedures. Currently, Illinois does not have a statute specifically requiring the coverage of weight reduction services for morbidly obese individuals when such treatment has been determined by a physician to be medically necessary. POSSIBLE REMEDY: Amend the Insurance Code, the HMO Act, and the Voluntary Health Services Plans Act to require all plans to pay for medically necessary weight reduction services for morbidly obese individuals. The requirement should include a definition of what constitutes morbid obesity. The benefit should be provided at the same level as other diseases covered under the insurance contract. Since this remedy would establish a mandated benefit, the Department defers to the General Assembly and the Governor's Office to establish public policy in this area. In establishing such a policy, the benefits of the mandate to those desiring the coverage need to be weighed against the cost of the mandate to all covered individuals.

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