In those states of the US where bariatric procedure is regarded as an Essential Health Benefit, Obamacare makes it mandatory for insurance providers to ensure that bariatric surgery coverage is given under all small-group, family and individual plans under the Affordable Care Act.
In this article, we list the states that are covered, illustrate the limitations of the act, and tell you what to do if your state is not included.
States covered for bariatric surgery under Obamacare
Excluding a select few, nearly all states make it mandatory for all small-group, individual and family plans to provide bariatric benefits. Residents from Arizona, Delaware, California, Hawaii and Illinois can obtain bariatric surgery benefits. Those who live in Maine, Iowa, Michigan, Maryland or Massachusetts are also eligible. In addition to that, people from Nevada, New Jersey, New Hampshire and New Mexico can benefit from the act, too.
Other states that make bariatric surgery insurance benefits mandatory are North Carolina, New York, Oklahoma, North Dakota, Vermont, South Dakota, Rhode Island, West Virginia and Wyoming.
If your state is excluded
In the event that the above paragraph did not mention your state, it is likely that your insurer is not obligated to give you any bariatric surgery benefit. Even when you get your surgery done in some other state, you will still not be able to claim any benefits. The good news is that many organizations and authorities are working hard to change certain policies of the Affordable Care Act in order to make bariatric surgery mandatory within more states.
Is there any other catch?
Since the act treats bariatric surgery as an Essential Health Benefit, the initiative is of no use in case of larger groups. That is, if a group has more than 50 employees, then Essential Benefits are not going to apply. That means if you work in a company having over 50 employees, you will not be eligible for receiving bariatric insurance coverage.
What if you are unsure?
In case you are unsure whether your insurance provider gives you bariatric surgery benefits or not, you may want to contact a local bariatric surgeon. Without charging you anything, the surgeon’s office will get in touch with your insurer and obtain information on your behalf. After that, it is great if you find that the procedure is covered by your insurance provider! But at the same time, there is no reason to lose heart even if your insurance company informs that it does not cover the procedure. That is because you can still get secured and unsecured loans from various sources to cover the costs.