Question:
Does anyone working for the state of Texas been approved by

BC/BS Healthselect Ins? And if so how did you get approved for this Surgery?    — mischief85 (posted on May 28, 2002)

June 12, 2002
Written exclusion? I've got that problem w/State of TX BC/BS too...I've read somewhere on this site that someone went in for gall bladder surgery, which was covered, and then they self-payed the remainder for the WLS. I have no idea how big of an expense this was, but I'm sure it was a savings of some kind...I just think it's crap that they have this exclusion to begin with.
   — Lynda L.

July 8, 2002
GOOD NEWS for BCBS of TEXAS insured folks: I've been working w/the group at COMPASS, used to be IMAGES, and they've confirmed that the exclusion isn't iron-clad...the medical necessity option has worked, and they're working with me to get approval based on that. I know there are several who've tried to get past this based on a LOMN and were denied, but my case-worker lady seems confident based on the information provided by her contact at BCBSTX. See below: Dear Lynda, I spoke with Lettie at Blue Cross today and was told that they will consider this surgery if medically necessary, however as you have an HMO they will not allow you to go out of network. I noticed that you stated that you will roll over to PPO in September. I would suggest we wait until after September 1 to submit the letter of medical necessity for approval as they will certainly deny it due to being out of network. Please let me know how you would like to proceed and thanks for letting us know that they will consider this procedure. Up to now we have always been told that this was a "definite exclusion" on this policy even with medical necessity. Thanks and I look forward to hearing from you. Sheridan at Compass GOOD LUCK EVERYONE!! :)
   — Lynda L.