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Asad Rahman
Asad Rahman, Lawyer
Category: Employment Law
Satisfied Customers: 2102
Experience:  Practicing Attorney with 10 years experience
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After undergoing privately paid bariatric surgery, my

Customer Question

After undergoing privately paid bariatric surgery, my husband is now being charged for complications due to that surgery (not all, but some). I read that the Federal Government, under the ACA, regulates self funded insurance (which we have). The ACA also obligates companies to cover bariatric surgery and its and complications. In addition, although the original surgery was "elective," the complications were "medically necessary" and life threatening. He was denied coverage for intravenous feeding and antibiotics while his stomach healed from the surgery. I understand the appeal process with the administrator but would like to cite the sections of law that may override their denial "this obesity service is not covered." I know full well they will issue an another denial but I need something to back this up before taking it to State or Federal appeals. I need to know the specific section of the ACA that addresses this issue and where to seek help from the Federal Government.
Submitted: 6 months ago.
Category: Employment Law
Expert:  Asad Rahman replied 6 months ago.

Unfortunately your information is slightly incorrect. The ACA did allow for bariatric surgery to be a covered service under a standard plan that each state could pick for themselves. Washington apparently does not include that. However, your policy language should be explicit about medically necessary treatment. I had a similar situation with a family member who did not have pregnancy coverage but did receive coverage for her medically necessary c-section, etc.

Expert:  Asad Rahman replied 6 months ago.

The only Washington state citation that covers required feeding is http://app.leg.wa.gov/WAC/default.aspx?cite=182-554-300

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