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| Author | Message |
 Amarillo, TX Member Since: 08/21/04 [Latest Posts] | Post Date: 5/25/08 4:24 pm Anyone having any luck with BCBS of TX paying WLS yet? |
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 Lytle, TX Member Since: 06/01/05 [Latest Posts] | Post Date: 5/25/08 4:28 pm Yes, I have. I have BCBS of Texas TRS Activecare (I am a teacher) I was denied first because I didn't go to my doctor every month for the supervised diet but once that was complete it took about a month for me to be approved. overall it was a 2 year ordeal but that was before they changed the supervised diet from 12 months to 6 months.
Are you having any particular difficulties with them or are you just curious?
Thanks Leann  |
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 Huntsville, TX Member Since: 05/18/08 [Latest Posts] | Post Date: 5/25/08 10:00 pm LeAnn,
How much did you end up paying out of pocket (co-pays, deductibles, etc.)? I have TRS ActiveCare also and I am just wondering what to expect. I have pre-op work scheduled for June 23 and surgery on July 1. Just wondering what to expect.
Jennifer |
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Amarillo, TX Member Since: 08/21/04 [Latest Posts] | Post Date: 5/26/08 6:09 pm I had BCBS of TX thru my employer and was told there is a clause denying WLS never had any options. A flat NO! even with Dr. approval, several co-morbidities, etc.
A year ago we switched to United Healthcare but only kept one year. Now we are back with BCBS of TX. Part of the problem is it is a small group employer. Just wanted to know if they have come to their senses the past year or so.
Shanna |
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 Houston, TX Member Since: 12/29/04 [Latest Posts] | Post Date: 5/25/08 5:58 pm It took me TWO YEARS but I finally got them to pay. Lynne |
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 Plainview, TX Member Since: 03/29/06 [Latest Posts] | Post Date: 5/25/08 8:23 pm I had federal BCBS. It paid 100%, no deductible, for my husband and I. No pre diet or anything.
Good Luck,
Sherry Highest/Surgery/Current/Goal John 341/331/163/185 Sherry 345/338/201/165 John 22 lbs below goal Sherry 47 lbs till goal JOHN Sherry 122 inches lost   |
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 Friendswood, TX Member Since: 01/22/08 [Latest Posts] | Post Date: 5/25/08 9:51 pm Last Edit: 5/25/08 9:51 pm I have BCBS Anthem but I have been told we are self-insured and BCBS just handles the paperwork. No pre-op diet, approved in one week. Pays 100% to surgeon and $200 co-pay for overnight hospital stay. There is no "standard" BCBS policy - you have to check with BCBS to find out what they wrote for your company. |
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Huntsville, TX Member Since: 05/18/08 [Latest Posts] | Post Date: 5/25/08 9:58 pm I have BC/BS Texas (TRS ActiveCare) as a teacher. I was approved on the first try. I followed the 6 month medically supervised diet plan and all the paperwork was submitted and approved. Make sure you follow all the requirements to the letter and all should be fine if your particular plan allows for it. Let us know how it goes.
Jennifer |
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 McKinney, TX Member Since: 05/18/08 [Latest Posts] | Post Date: 5/25/08 10:03 pm I have NOT been successful with BCBS TX, let me tell you my frustration with them!  They tell me for approval my BMI has to be 40 or higher & mine is currently 34.7 ( although I have been much heavier years past with a BMI of 42 ), I guess it would have been financially smarter for me to have stayed that big and gotten approved for WLS. Instead I tried and succeeded in losing 45 pounds on my own, but have not been able to get the other 90 pounds off and I have been struggling with losing and gaining the same 10 pounds over & over & over for the past 2 years. Instead I have opted to finance the surgery (it will be like a car payment  ), although I am still going to try to get BCBS to pay, I refuse to let them decide what's right for me.
Good luck on your journey - I hope you can get them to pay for your WLS.
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 Cleburne, TX Member Since: 12/05/07 [Latest Posts] | Post Date: 5/26/08 6:46 pm I have BCBS of TX TRS Active Care 2. My cousin also has the same insurance, same level. She had surgery in Feb. She said that it paid all but 10%. She did the whole medically supervised diet, had diabetes, etc. Right now I'm waiting on approval. There was a screw up at my doctors office and it wasn't submitted when it was "supposed" to be. It was "re"submitted 5/23, origionally it was "submitted" 5/15. I'm frustrated with them.
Mother to three, ages 7, 6 and 3, nursing student, recently engaged. =D |
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Friendswood, TX Member Since: 01/22/08 [Latest Posts] | Post Date: 5/26/08 7:47 pm Last Edit: 5/26/08 9:31 pm On May 26, 2008 at 6:46 PM Pacific Time, Chivas L. wrote:
I have BCBS of TX TRS Active Care 2. My cousin also has the same insurance, same level. She had surgery in Feb. She said that it paid all but 10%. She did the whole medically supervised diet, had diabetes, etc. Right now I'm waiting on approval. There was a screw up at my doctors office and it wasn't submitted when it was "supposed" to be. It was "re"submitted 5/23, origionally it was "submitted" 5/15. I'm frustrated with them. I know how you feel - believe me! My doctor's staff took 3 weeks to fax the paperwork over to BCBS. I was so aggravated... grrrr....... I know they are busy, but come on - 3 weeks? I waited a week and then I called BCBS to make SURE they had my paperwork and I almost dropped the phone when the lady said I had been approved. I must have sounded like an idiot with a comprehension problem. I kept saying "Really ?? Are you SURE" "I have actually been A-P-P-R-O-V-E-D"?" I hope you hear something soon! |
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 Bryan, TX Member Since: 09/13/04 [Latest Posts] | Post Date: 5/27/08 7:56 am Shanna,
It all depends on what your employer has in their clause. I work for the state and have BCBS of TX PPO. THey denied my Lap Band request and denied the appeal, but after I met teh 6 month doctor visits, over 40 BMI, documetation, etc. I was approved and had surgery in less than two weeks. My husband was denied by his insurance and approved under mine in less than three weeks.
Don't give up. Look at he link that Paul gave you. Call the number on your card and ask if they cover WLS. Be specific, say lapband, DS, RNY, etc. If they say yes, ask what the criteria for coverage is.
Good Luck!
Gina Gina L |
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 NC Member Since: 07/16/08 [Latest Posts] | Post Date: 12/25/08 4:00 pm I am fustrated with them. :-( First they said it was covered and I went though the six monthly visits routine. Now they say it isn't. That put off my hernia surgery six months. Now it can't wait, it should have been done months ago. Maybe they will change their mind on the band after I recover from the hernia surgery.. |
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Amarillo, TX Member Since: 08/21/04 [Latest Posts] | Post Date: 12/31/08 6:22 pm I have not tried anything lately but I need to back to work on it. What really bothers me is the BCBS says my employer put the clause in the policy for no WLS. I have talked to my employer and they did not put it there. So that tells me BCBS puts it in the policy and lies to the policy holder knowing they probably wont go any further with it. I think its time to start over again and really put up a fight. Maybe get a lawyer to help. Shanna |
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 Member Since: 03/15/10 [Latest Posts] | Post Date: 3/22/10 7:06 pm I apologize as I know that this is an old thread and I seem to be jumping on the band wagon a little late, but to those of you that have been able to get Blue Cross Blue Shield of TX PPO to pay, "you are my heroes". I want to be you when I grow up! I have insurance that the State of Texas sponsors for people that are considered so high risk that they are uninsurable (see link below for those interested - there are pools in most other states as well). My dilemma is that BCBS's "Outline of Coverage" states that it won't cover treatment of obesity as detailed below. I have read all five plans and for those of you that may like to read the nitty-gritty, here it is in black in white: - Bariatric surgical procedures or complications related to such surgeries, even if the Insured Person has other health conditions that are related to, caused by or impacted by excess weight, obesity or morbid obesity, or any program, product or medical treatment for weight reduction or any expenses of any kind to treat obesity, weight control or reduction. AND   |
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Amarillo, TX Member Since: 08/21/04 [Latest Posts] | Post Date: 3/24/10 6:37 pm Hi Shelby, I too have had BCBS of TX. I finally got someone at BCBS to tell me the truth. What they are telling all the folks covered by them is that the employer is putting the clause in the policy but it is BCBS is putting the clause in the policy. So BCBS puts it in the policy, tells the employee that the employer has put the clause in the policy so everyone gives up on trying to pursue it any further and BCBS (as well as other ins. companies) are getting away with it. I was told by BCBS that when an employer is shopping for insurance for its employees they just pick the policy that is right for them such as deductibles, prescriptions, copays, cost, etc. Kind of an off the shelf type of purchase. The employer doesn't know that this particular exclusion is in the policy and BCBS (and others) are getting out paying for WLS. Some of the BCBS policies in other states will pay for WLS but not good ole BSBS of TEXAS. I have been switched to United Healhcare and it is the same problem. They just picked out the same type of policy. I know this is not right and I wish I knew how to fight it. I am also afraid to push to hard for fear of the insurance doing something against the company I work for such as dropping us, raising the rates sky high, etc. My daughter had the RNY last Oct. (and is looking great!). She is covered from her job and her husband covers them too at his job. BOTH policies covered her surgery!!!! Neither one batted an eye about coverage. I know there are insurance companies that are getting it and realize how many complications will improve or go away with the WLS but the others are just looking at their bottom line (and are getting away with it). So I am just as frustrated & angry about this as you. I have worked on this for several years, had my drs. write letters been to Dr. Warnock in Wichita Falls & another Dr here in Amarillo, been to 2 or 3 seminars, read all the WL books, have all the health issues, am willing to go thru the 6 month program that the new dr here in Amarillo requires before surgery but I can't even get an consult appt with him because ins. wont pay for even an office call on bariatrics. PERIOD!! Of course I can see him if I want to pay cash but why pay $200+ office call when I can't get the surgery. The only other way is cash and I don't have $25,000+ in my back pocket. I am so ready for WLS and so frustrated!! I know this doesn't help solve our problems but it is sure nice to vent to someone who understands. Hope I didn't ramble on too much. Shanna |
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Member Since: 03/15/10 [Latest Posts] | Post Date: 3/28/10 6:58 pm Thank you Shanna! I'm sorry to hear about all of the problems that you have had with your insurance company. It's hard to know where to begin when both parties are pointing fingers at each other - especially when you are in my scenario, you only have one option for insurance, and/or you can't exactly call the State of Texas to complain about the limitation placed upon the plan they have been gracious enough to supplement with grant money from our taxpayers dollars foods so people like my husband and I will have insurance. It seems like from a sheer economic perspective they would begin to have caught on by now. I noticed that you aren't that far from me. I wanted to pass on some information about the doctor that I would like to do my surgery, Dr. Nick Nicholson. One of the things he offers, other than cash pay, is a payment plan since they understand that a lot of people are making payments for their surgeries. They have catered to this niche of the market by working with the Baylor Healthcare System to set prices for the RNY, Lap-Band, and Sleeve ranging from $12,000-$17,000. The nice thing about this option is that there is an exact price without absolutely any financial surprises which we can't always say about insurance when it does cover the surgery. I have attached a link for him in the event that you are interested. http://www.nicholsonclinic.com/payment/ |
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 broussard, LA Member Since: 09/06/09 [Latest Posts] | Post Date: 4/2/10 11:37 am It must be the policy u have cause I have BCBS of TX and it is covering my revision from lapband to Bypass...I paid for my BAND and they r paying for my BYPASS....Good luck |
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 Member Since: 05/01/10 [Latest Posts] | Post Date: 5/25/10 9:33 pm I am a teacher and I have BCBS Active Care 2. It covers WLS as long as they are done at a Blue Distinction Center with 3 month medically supervised diet. All versions of BCBS are not the same and it appears that your coverage is dependent on the policy your employer picked. Apparently the plan choosen for Texas teachers does cover weight loss surgery. |
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