OK General Question

Is there any one out there that knows of a Califonia Law that requires WLS to be covered by Insurance Companies that write group health insurance policies in this state.

feel free to contact me here.  This question is of personal interest to me.  I live in maryland but my group health insurance is written and governed by the state of Califiornia.


Hugs from baltimore

Lori

For detailed information I would suggest contacting my attorney www.obesitylaw.com   They were instrumental in helping me win my appeal to have my RNY two years ago. The process also gave me a crash course in insurance.

Its my understanding that HMOs that are licensed to operate in the state of California are required to offer WLS as long as the patient qualifies with a BMI of 35+ or a BMI of 32+ with at least 2 comorbities. (I might have the BMI numbers wrong though...)

You must first got through the appeal process with your insurance company and if they deny you, you can then file a complaint with the Department of Managed Healthcare in California. Most of the time, once a case reaches the DMHC they will almost always rule in favor of the patient.

Good luck on your fight!

 

The best person to answer this question would be Diana, who posts on the DS forum. She is an attorney who has helped many people, esp in CA, fight their HMO's to get the DS, and I'm sure she would have an answer for you.
     And while you're at it, you might want to learn more about the DS, esp since you have been diagnosed with type 2 diabetes. The DS has the highest rate of resolution (some would say cure) for type 2 diabetes - 98%. RNY resolution rate is usually cited at about 84%. But there is new data coming out that with RNY, the diabetes can return a few years later, esp if there is weight regain - in other words, the diabetes in not cured, it's just in remission. And while we all go into whatever surgery we have committed to making it work, the reality is that weight regain is a significant problem with RNY. Yes, some people do great and are very happy with it, but the overall failure rate for RNY is about 30%.
    Come over to the DS forum, learn more about it, and do a shout out to Diana for insurance questions. She knows her stuff.

Larra