state laws on insurance and WLS

Does anyone know if any of the states have enacted legislation that would require a insurance company to cover WLS?

These four states have a law that insurance companies have to cover WLS assuming its not self-funded. Georgia, Indiana, Maryland, & Virginia I hope this answers your question

Do you have any more information on Georgia's laws...or know where I can look for it? Thanks, K

http://www.wlscenter.com/ResearchArticles/georgia_wls_law.htm

Thanks Monica! I came across that site around the time this link originally appeared. I did a *tiny* bit of research and as far as I can tell, this is a Bill that was never passed. Does anyone know any differently? Thanks, K

New York also. There are 6 total.

What's the 6th state? I have Georgia, Indiana, Maryland, Virginia and New York. That's 5. Anyone know what the law in Tennesse is? If there is one. -Maria

Gary, What do these laws mean exactly? I live in Indiana. I have a primary, secondary and medicare. I am working through the primary right now. But their requirements, I think, are going to be unrealistic to meet. (18 month consecutive weight loss). I am just not sure at what point I can go to the secondary. I think the primary will drag it out with their requirements rather than a flat out denial. Does that make sense? I do not want to wait 18 more months. I am in extreme pain from an allergy to insulin. 18 more months of this pain is like a death sentence to me. Vicki in Indy

NJ. Some states have a law that basically allows for external review of claims like these and if the claim is medically necessary, regardless of whether it is excluded or not, the carrier must cover it if the external review company, or IRO finds that it is medically necessary. They don't leave it up to your doctor anymore because then some doctors would say everything is necessary like plastic surgery etc.. when it is elective. Albeit some plastics are necessary lol. If you ask me, every state should have the same laws. Oh and Indiana is very good to deal with, at least it has been so far. Gary

Unfortunately, most people who are covered under their employer, are covered under an Employee Benefit Plan (self insured) rather than an insurance policy (fully insured) so the statutory requirements don't apply. Some states also have statutes regarding medical necessity, like North Carolina. In NC, insurance companies have to follow the statutory definition of medical necessity, and can't require anything additional (like a 6-18 month diet documentation.) Again, this is only for fully insured coverage...