A question for Gary Viscio

Hi Gary, Just wondering. I was reading through the Texas Legislature Statutes regarding health insurance and came across the following: "(m) A large employer health benefit plan may not, by use of a rider or amendment applicable to a specific individual, limit or exclude coverage by type of illness, treatment, medical condition, or accident, except for a preexisting condition permitted under Article 26.90 of this code." Since obesity has been labeled a "disease" that this helps our case as far as disputing exclusions. Please advise. Thanks, Robin

Well, I am not giving legal advice technically without knowing all of the facts, and I've seen that statute so I can give you my personal quasi legal advice. There are two issues here. But prior to that, I would use this as an argument in your appeals 100% every time. Let them disclaim, deny or defend it. But two things. 1. Tommy Thompson stopped just short of labeling obesity as a disease if you or they really nit pick. He said it was an illness. And that is a problem. It has pryed open a door but not opened it yet. The second is that this amendment would probably apply only to non-self funded ERISA governed plans which means those plans would still be out of luck. Personally, I have issues with the wording. I use these grey areas to win appeals, but if you think about it. What was defined as a large employer? and also, they say by use of rider or amendment, which seems to mean that they can exclude it in a new policy or allow an exclusion to stand, they just cannot change the policy midstream. Gary Viscio www.obesitylawyers.com

Well, I am not giving legal advice technically without knowing all of the facts, and I've seen that statute so I can give you my personal quasi legal advice. There are two issues here. But prior to that, I would use this as an argument in your appeals 100% every time. Let them disclaim, deny or defend it. But two things. 1. Tommy Thompson stopped just short of labeling obesity as a disease if you or they really nit pick. He said it was an illness. And that is a problem. It has pryed open a door but not opened it yet. The second is that this amendment would probably apply only to non-self funded ERISA governed plans which means those plans would still be out of luck. Personally, I have issues with the wording. I use these grey areas to win appeals, but if you think about it. What was defined as a large employer? and also, they say by use of rider or amendment, which seems to mean that they can exclude it in a new policy or allow an exclusion to stand, they just cannot change the policy midstream. Good luck Gary Viscio obesitylawyers.com