NJ Mandate that Laurel Mentioned

Thanks Laurel for shining the light on what a *wonderful* state we have in New Jersey that would set a great example by mandating insurance to not exclude WLS. A search came up with this link to a PDF file from the official State of New Jersey website. It is addresses to "All Health Maintenance Organizations Doing Business in New Jersey" http://www.state.nj.us/health/hcsa/bulletins/omc2005-03.pdf Malinda

This mandate is for HMO's only. It does NOT talk about the vast majority of New Jerseyans. Companies that self insure for example, or PPO's are NOT covered. Based on the insurance offerings for my husbands employer (one of the self insured companies) HMO's are definitely on the decline, if not on the way out entirely. Irene

I have Horizon NJ Plus. My surgeon is no longer in network. I have in and out benefits. NJ Plus denied my revision. Not medically necessary. They can deny anything based on that. I appealed and finally won. I also find when you call them ten different people will give you ten different stories. I had to also appeal for a sleep apnea dental device. I was told it was covered 90 percent but they only paid 70. I call back and the guys says he doesn't know why they didn't just cover it. They need to hire competent people. That is a whole other discussion though. I'm glad the state is getting on track. Maybe they realize they spend more money on the co-morbs then the surgery.