TENNESSEE must cover WLS beginning 1/1/06!!!!!

HELLO EVERYONE! I just found info on a new law that was passed requiring ALL insurance companies to COVER bariatric surgery for the treatment of morbid obesity beginning January 1, 2006 in the state of TENNESSEE!!! This is what I found as listed on the TN General Assembly's website, http://www.legislature.state.tn.us/ I copied and pasted most of it but not all of it. To read all of it, go to their website and plug in either Senate Bill 786 (SB0786) or House Bill 90 (HB0090): Here it is: "Notwithstanding any other provision of law to the contrary, any individual, franchise, blanket, or group health insurance policy, medical service plan contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society, health maintenance organization, preferred provider organization, or managed care organization which provides hospital, surgical, or medical expense insurance shall offer and make available coverage under any such policy, contract, or plan for bariatric surgery for the treatment of morbid obesity." "The provisions of this section are applicable to all health benefit policies, programs, or contracts which are offered by commercial insurance companies, nonprofit insurance companies, health maintenance organizations, preferred provider organizations, and managed care organizations, and which are entered into, delivered, issued for delivery, amended, or renewed after January 1, 2006." "Reimbursement for the treatment of morbid obesity by bariatric surgery shall be determined according to the same formula by which charges are developed for other medical and surgical procedures. Such coverage shall have durational limits, dollar limits, deductibles, copayments, and coinsurance factors that are no less favorable than for other types of major surgery for treatment of physical illness or disease generally. Standards and criteria, including those related to diet, used by insurers to approve or restrict access to bariatric surgery for morbid obesity shall be based upon current clinical guidelines recognized by the National Institutes of Health. Those standards may include the requirement that an insured document that physician supervised weight control treatment has been ineffective in reducing the insured's weight below the levels articulated for morbid obesity, whether or not the policy, contract, or plan provides coverage for physician supervised weight control treatment. The surgeons contracted by the insurers to provide bariatric surgery for morbid obesity shall have current experience in bariatric surgery and shall meet the standards set forth by the American Society of Bariatric Surgery and the National Institutes of Health, if any." "SECTION 2. This act shall take effect on January 1, 2006, the public welfare requiring it." HOORAY!!!!! I thought maybe this info. might help someone else out too and if you don't live in TN, maybe you can research your own state's legislation. I am very excited and hope that I am interpreting this info. correctly. Any feedback would be greatly appreciated (especially from our lawyer friends LOL)!!!!!!!!!! Tammy

Hooray for residents of TN!!!!! Now, if all states would just have the same mandates. It really IS unfair that the insurance companies have been allowed to discriminate against this type of life-saving surgery, and most are still getting away with it! Dawn

Well I guess my bubble has been burst. Someone just replied to my post on the TN state message board and told me that those 2 bills are still going through congress and have not yet been passed. Oh well... This is usually how my luck goes. I will keep my fingers and toes crossed (wish I could cross my legs too, ha ha ha ) and pray, pray, pray, that those bills are passed ASAP!!! I have to keep reminding myself to never, never, never give up hope. Tammy ***Sure do hope that some of our lawyer buddies can offer some insight on this issue (these bills SB0786 and HB0090).***

but they are at least CONSIDERING it, which is more than other states are doing, as far as I know!! Let's pray they get passed and that others will follow suit!!

AMEN!!!

Could someone fill me in on this? Has this Bill been passed?? Where do I go to find this information out? (passed or not passed) Thanks in advance!

Hi Rhonda! I thought the bill had been passed but someone told me that it hasn't been passed yet. But the bill is currently being reviewed by the House and Senate. It has already passed the 1st and 2nd considerations. If passed, the law is to take effect 1/1/06. Go to: http://www.legislature.state.tn.us/ and look up Senate Bill 786 (SB0786) or House Bill 90 (HB0090). Someone else told me that we should know something by the end of this month or next month because the house is currently in session now. That is all I know but I will keep ya posted with any new info I find out! I know how important this bill is for all of us living in TN. I also have BCBS of TN (they suck!). Good luck and DON'T GIVE UP!!! Keep fighting. Feel free to email me if you'd like. Tammy

That's the spirit. NEVER GIVE UP If I had given up and let the Insurance company win I would not be where I'm at now. I have Gary to thank for being on my side when I needed him the most. Donna 338/227 -111

Thank you for your support Donna I am so happy for you on your weight loss success!!! I know that the end result is worth all this fighting and someday the insurance companies are going to have to pay for this life saving surgery whether they want to or not! Phewey on them! LOL!!!!! Tammy

Well, now, the question here is ----Can the insurance companies still place an exclusion in their policies so they don't have to cover WLS????