| 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 341/331/166/185 Sherry 345/338/188/160 John 19 lbs below goal Sherry 28 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.
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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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