NJ + WLS Perfect Together

Hi Guys! Anyone being told in New Jersey that thier medical insurance policy has an exclusion for WLS is being given INACCURATE information. On June 30, 2005, the NJ State Legislature mandated that insurance companies in New Jersey CAN NOT exclude WLS from thier policies. This means, even if you are told that your place of employment, or where ever you get your insurance from, needed to purchase a rider to include WLS in your policy. THAT IS WRONG. WLS can not be excluded from an insurance policy in New Jersey. Even NICE reps at insurance companies are not fully up to speed on this information. Push them to find out more! From what I have learned, there are not many states that have this mandate. We're lucky to be in NJ! Laurel

TELL US MORE, DO YOU HAVE THE BILL NUMBER? OR NAME OF THE BILL.

I don't want to bore anyone, I might have posted bits and pieces about this in the past, but here goes. First I don't know the bill number or name...BUT IT IS DEFINITE...the bill was passed on June 30th, 2005. Aetna gave me this information and they would not give me information like that unless it was true. Here's the story... In July, I started thinking about having WLS. I automatically assumed the my insurance would cover it. I have my insurance through my husband's place of his employment and he works for a huge company with excellent benefits. I didn't even know some insurance companies excluded WLS form policies. Well, to my surprise, when I called Aetna, they told me that the surgery was excluded from my policy. I then called the employee benefits department and was told by a low level nobody that that was correct....WLS not covered. At that point, the wind was knocked from my sails and I was trying to figure out how to pay for the surgery. In August, I called Aetna for another matter, and I was talking to someone that sounded like she was intelligent so I asked her to confirm that there was an exclusion to the policy. She unfortunately got back on the line and told me that there was an exclusion to my policy and I was not covered. So now this is three people that I spoke with that told me I was not covered. A couple of weeks ago, I was on Aetna's navigator web site and I read something that sounded like there might be a loophole about getting approved to have the surgery. I called Aetna, and spoke to a woman who said to me after we talked for a few minutes"Are you from New Jersey"? And I said "Yes" She said...well the exclusion thing doesn't even pertain to you...Your state, New Jersey passed a bill on June 30th of this year, making it illegal to exclude WLS from insurance policies." WoooHoooo! That was on a Friday afternoon. I was thrilled all weekend after I got the news. By Sunday night, I said to my self, "self, you better call again and get that information confirmed"...(since I had gotten conflicting information already, I figured I should call one more time.) I called again on Monday and again was told again about the New Jersey State mandate about prohibiting WLS exclusions. Excellent! A week later I had my consult with the surgeon. A few days after that, while I was getting my paprework in order, I started talking to myself again..."self, you better get that thing in writing from Aetna about no exclusions in NJ" So I e-mailed aetna, and 24 hours later I received a response telling me there WAS and exclusion to my policy. ****! I immediately called member services, and spoke to a wonderful woman who apologized for the inconsistent information,she read the wording of the mandate to me over the phone and said it went into effect on June 30th. She went on to say that since it is such a new bill, many of the Aetna Reps are not up to speed on the mandate.(I'm sure AETNA isn't chomping at the bit to give people this news) She then went on to tell me that she had the WLS two years ago and how well she is doing. She thoroughly checked out the information for me and told me that there is no way she would give me erroneous information on this issue as she knows how important it is. This is what I know, so If anyone in NJ has been told since 6-30-05 that there is an exclusion to thier policy....call again and AGAIN. I hope this helps even just one potential loser. Laurel

hi laurel, that is just wonderfull for us in jersey !!!!!! I'm so happy to know this as I was just turned down by cigna!!! i am telling my other wl buddies who have been turned down. franni

I was just informed by another NJ message board visitor that the mandate only specifies HMO's as having to not exclude the WLS. Still, it's something. I hope you have an HMO

laurel, no i don't have a hmo. I may be self pay but will now have to research all over again. My surgeon is Kirkland (friend had Wernsing).Excellent doctors. You may see me going to spain. Most of my pre-op already done. franni

In addition, the mandate doesn't apply to national insurance carriers. irene

Thanks for sharing : ) I appreciated the information Timmy Ray

Has anyone since this post been able to get the exact bill number? ~Kristin