any help?

Hello All, My older brother recently found out that there is a WLS clause in his insurance policy. He has severe Sleep Apnea and HBP. His sleep study came back with 51 episodes in one hour! He is obese and I feel like he would benefit in so many ways from this surgery. I heard that in the state of VA you cannot be denied if it is medically necessary. Does anyone have any suggestions with this process? His insurance is an HMO through MAMSI. Thanks, Court

Unfortunately, there is no laws that pertain to WLS. The only thing on the books is that the insurance company has to offer a "rider" to the employer. If the employer decides to take on the expense, they can. If there is a clause in his insurance company, he needs to get it in writing and check out the wording. Sometimes it will say "only if medical necessary". Sometimes it will say "obesity" instead of "morbid Obesity" which is a totally different thing. Unfortunately insurance companies are making their exclusions pretty ironclad. Jane

I think the law you are talking about was passed in Maryland recently. CathyA

The law in VA keeps getting shelved and I do not believe it has been voted on yet by the state. I know that there have been phone call, email campaigns to contact state legislature folks. A number of folks have gone to Richmond when it was supposed to be voted on but it got tied up in committee time and time again. Not sure where it is now. MD does have the law that requires coverage. Kathy

Hey Courtney!! I have the same insurance as your brother. Took me a year, but I did get approved. Slow and steady wins the race, AND trust me............it's a race he CAN win!!! Read my profile and let me know if you need any further help. OXOXOXOOX Sharon