Question:
This is gonna sound stupid...but what chances do I have of blue cross blue shield of
texas paying? Does anyone know if I will be in for a fight?What exactly do they require? PLease help! — [Anonymous] (posted on May 21, 2001)
May 21, 2001
Don't feel stupid! It's an excellent question. I'm with BCBS TX also, so
PLEASE, someone out there help us out with a response! Thanks.
— Val D.
May 21, 2001
Hi. I don't have BC/BS...however, if you go to the Library page on the
website, you can research specific insurers.....I found lots of good info
about my carrier there. Also, at the top of the page, there is an
"Insurers" link...try it too. Best of luck to you.
— blee01
May 21, 2001
I don't have BCBS of TX but do have BCBS of KS (with a weight loss
exclusion clause that includes meds, tx., and surgery). I am not very
hopeful. I am furious that BCBS is allowed to pick and chose which
diseases they will cover. When will they learn preventive medicine is
better than teriary care. Good Luck. (PS I'm still trying to figure out
how to make them pay, and if not how to come up with the bucks pre-surgery
to get this care!)
— Krista L. S.
May 21, 2001
I had BC/BS of Georgia and am under the federal plan. They paid for
mine!!!!! Under the exculsion part mine mentioned that they did not pay for
diet medication or plans but had an exception for weight loss surgery!
Read your plan carefully and then call and ask if it will pay! Ask what
they require....I was lucky, I was not 100 pounds overweight, my BMI was
only 38 but I had health problems that paved the way. I was hypothyroid,
had a hysterectomy at the age of 35, just had knee surgery, bad back and a
host of family history of heart disease, diabetes and cancer. I have a new
friend that just had her surgery and she had a small plan that paid for
hers!!! Ask, just ask, if they say that they NEVER pay for it then find a
way to get a insurance company that will, it's worth it!
— Teresa M.
May 21, 2001
I don't have BCBS of Texas but I have BCBS of Minnesota and they covered my
surgery. The advice that Theresa Miller gave you is very good. I would
follow her advice and hopefully you will find that your plan covers the
surgery.
Ginny Newberry
— Ginny N.
May 21, 2001
I have BCBS but not of TX, but it seems that they are notorious for
approving request for wls. My policy covers wls but yet I'm still entangled
in a "knock-down-drag-out" brawl with them to approve my surgery.
If you are a state employee then you may have a much better chance,
because it's your employer who actually makes the decision, BCBS just does
the paperwork for them. I believe the same is true for federal employees
also.
— [Anonymous]
May 23, 2001
— Carrie S.
May 27, 2001
I have Blue Choice Option and I fought them for nine months.
I thought it would never end. The only thing I can say is you
might have to contact the Insurance commissoner of your state.
I was just about to do it when I finally got my approval.
I hate Blue Cross..... Rrrrrrr
— Danmark
May 30, 2001
I was just denied by BCBS of Texas. Have asked them what I can do for an
appeal. Here is their exact email to me: Terri, sorry for not answering
you sooner, but you were correct, I did not
receive it until today. Unfortunately your plan does not cover services
for
obesity, please see page 50 number 22 of the new benefit booklets, under
limitations and exclusions, which states, treatment for reduction of
obesity or weight, including surgical procedures, even if other health
conditions might be helped by the reduction are not covered.
Can someone out there help us on BCBS of TX out? PLEASE???
— Terri S.
May 30, 2001
First off, while your insurance may exclude procedures for obesity, they
may not exclude procedures for "MORBID" obesity....There is a
difference....Try to get approval using "MORBID OBESITY" as a
diagnosis.....
— Linda I.
January 17, 2003
I, too, have BCBS of Texas. My husband works for the state. They approved a
visit to see a Bariatric surgeon and then denied the benefit AFTER I went
to see him. I won that fight. But they have never, ever approved this
surgery That I know of, even when threatened with a lawsuit, all of which I
did. I sent letters, appeal letters, even questioned them approving the
visit to the bariatric surgeon for the purpose of being evaluated for WLS.
And there was no secret made about the reason for the visit. I mean, if you
absolutely exclude WLS each and every time, why would you ever approve a
visit for evaluation for WLS with a surgeon? And I still got denied, even
though I have been more than 100 pounds overweight for almost 20 years,
have an obstructive sleep disorder, degenerative arthritis, secondary
infertility, chronic shortness of breath and a decreased quality of life.
My option?? I obtained insurance at my new job and am working on the
process of getting approved.
— Terah62
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