Blue Cross Blue Shield of Texas

Anyone having any luck with BCBS of TX paying WLS yet?

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,

 

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 

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

It took me TWO YEARS but I finally got them to pay.

I had federal BCBS. It paid 100%, no deductible, for my husband and I. No pre diet or anything. Good Luck, Sherry

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.

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 

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.