success w/ fighting 18 mo preop diet w. 6 mo indiana mandate

hello all

i would like to know about ppl that there insurance required 18 mo. preop dieting but won on the 6 month indiana mandate.

 i have also been informed about ERISA???

I would also like to know about anyone that has dealt with their employee being subject/non subject to ERISA in dealing with the 18 mos vs. 6 mos preop dieting.

thanks all
TNG
aka
pam

Pam,

I'm a little confused. I googles ERISA and from what I read, it has to do with regulations that the government can enforce upon companies for retired emplyees. If you're old enough for retirement, you need a new pic on here girlfriend. Although it mentions medical coverage, it did not specifically state anything about weight loss surgery coverage as far as I can tell.

If you look back a few pages of posts, someone had posted a URL concerning the 6 month mandate.

Sherri

Hi Sherri

That's what I thought too, but I came across this after someone had made a comment on here about ERISA and the 18 mos vs 6 mos.  Cassie had made the comment that follows:

Post Date: 10/16/08 10:34 am
i had the same thing.   i talked to dr jones office and they had told me that it depends on the insurance company and your employer.  some are still able to get by with asking for the 18 months (i know it is stupid).  amy at dr jones office told me to ask is my employer was "subject to ERISA".  i dont really know what it means, but if your employer is subject to ERISA, they have to go by the 6 month law.  if they are not, then they can ask for 18 months, if that is the way your plan is written.  i had to do this stuff on my own.  i started the 18 months, and jumped thru all the hoops, but i was finally approved, and had my surgery 2 weeks ago tomorrow.  it is worth it, and even tho it sucks.... keep fighting it!!! my employer was subject to ERISA, and i still waited a year before i was approved!  DONT GIVE UP!@!!! 
cassie

now i am sooooooooooo lost, i don't know which end is up????

HELP?????

this is what i found about ERISA on the net

What is ERISA?

From Consumers For Quality Care

ERISA is  a 1974 federal law - the Employee Retirement Income and Security Act.  An unintended loophole of ERISA prevents patients with employer-paid health care from obtaining damages against HMOs that deny them medically necessary treatment. Currently, no matter how outrageous the corporate conduct, or serious the consequence of the treatment denial, patients *****ceive their health care through their employers cannot hold their HMO accountable.

Is Your Insurance Plan an ERISA Plan?

by Harvey Frey, MD, PhD, JD

ERISA does not govern if:

1. Your insurance is unconnected with your employment, or

2. The covered person is

i. self-employed (29 CFR 2510.3-3(b)), or

ii. is a partner in a professional partnership (29 CFR 2510.3-3(c)), or

iii.is a partner in a professional partnership (29 CFR 2510.3-3(c)), or

3. The insurance IS connected with your employment, but your employer

i. Is an agency of any level of government, or

ii. Is a religious organization (29 USC 1002(l)), or

iii. Is minimally involved, i.e.: The employer makes no contributions toward the premiums,  Participation is completely voluntary for the employees, employer doesn't "endorse" the program, the employer does no more than allow the insurer to publicize it to the employees, collect premiums through the payroll deduction, and remit them to the insurer; and the employer gets no compensation except for its administrative services. (29 CFR 2501.3-1(j))

Hi Sherri

I found some more info regarding ERISA

Check this link out and it helps explain a little bit

http://www.nase.org/news/sea/SEA_JulAug_99/erisa.htm

thanks!
pam