Question:
anyone in houston BC/BS ppo for wls
i just wanted to know if anyone has BC/BS ppo and used it successfully for wls and or ps. i live in south east texas in the clear lake area and just recently got my insurence through work, so i dont even have a regular doctor!!! — alaneanow (posted on April 9, 2007)
April 9, 2007
Hi Ashley, I too am covered by BCBS and have been told that though the
website for the insurance company shows that they do cover WLS, they will
not do so in my case because it depends on your employer -- my husband's
employer chose not to have WLS covered in his insurance so that means they
will not provide me insurance for the surgery I need and want. You need to
find out if your employer has chosen to have WLS covered. You can call
your HR department to find out. Hope this helps.
— cherub13
April 9, 2007
Yes, what Alison said and proceed ahead with obtaining a Primary Care
Physician because you will need a referral from them to even see a
bariatric surgeon --should your insurance cover the procedure. However,
always keep these two words in mind "medical necessity."
— the7thdean
April 10, 2007
I lived in Houston for 18 years; now live in NC. As far as a primary
doctor, I was aslways very satisfied with Kelsey Seybold doctors, if they
are still around. They had clinics all over the greater Houston area and
likely Clear Lake area. Stay away from MacGregor clinics! Hope this helps!
— ZephyrNC
April 10, 2007
Hi Ashley:
I have BC/BS PPO with Texas A&M University and they recently
(2006-2007) added weightloss surgery to the policy. I've been praying for
this for a long time and if finally happend! My advice to you is to check
out your benefits booklet and look under exclusions. In my benefits
booklet it said that bariatrics were not covered EXCEPT for surgical
weightloss (meaning "yes" they cover it). I then went to
ObesityHelp.com and found a topic that helps you with talking to your
insurance provider... what questions to ask. So, I printed those out and
called the insurance and we talked for 45 minutes about the documentation
required, having to be on a 6 month medically supervised diet (which I'm on
my first month), getting the letters of necessity from the surgeon and PCP
ect. WAIT UNTIL YOU HAVE ALL YOUR DOCUMENTATION IN AND HAVE CONFERRED WITH
YOUR SURGEON BEFORE SUBMITTING THE PAPERWORK OR THEY'LL DENY IT... they
want EVERYTHING IN AT ONCE. Your surgeon's office will take care of a lot
of that for you, but you have to be proactive and follow through with what
your insurance requires and the doctors' offices are usually swamped by the
extreme patient loads so they forget and lose track of time. I told myself
that this is the most important thing I could do for myself and my children
so will be taking an active roll throughout the 6 months of waiting. I
wish BC/BS didn't require that, but it does. Oh, another thing, my
insurance says that if you have a BMI of 40 or above you don't have to list
any co-morbidities (diabetes, hypertension, heart disease, etc.). This is
the webpage my insurance rep guided me to... know this is for MY
employer... but yours should have something similar if they cover it:
http://medicalpolicy.hcsc.net/medpolicies/disclaimer#hlink
Hit the "I Agree Button"
Oh, and get a PCP as soon as you're able to. You can go to him/her for
your 6 (consecutive) month diet requirment instead of paying a higher rate
for a specialist in nutrition.
Good luck! I'm at the beginning of this process so will figure it out as I
go.
Hanging on a wing and a prayer,
Carolyn L.
— Carolyn Lacy
April 10, 2007
I have BC/BS of Texas. I'm having my surgery on Thursday! The requirements
under my plan was that you have to have a BMI over 40, or 35 and above with
comorbidities. They also required that I have a 6 month diet/exercise
program that is medically supervised. I went to my pcp every month for 7
months (just in case they consider the first month a consultation) and they
weighed me, took my blood pressure, temp, and the doc and I would discuss
my diet, and what I was doing for exercise. He documented everything, and
at the end he typed me up a letter of recommendation for the surgery. FYI,
weight loss surgery was not excluded by my employer.
— Skygirl
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