BCBS TRS Activecare Questions...

Poodles
on 7/28/11 8:55 am - TX
Figured I would post this here, because it is about TX teachers plan and when I checked out the insurance forum it did not look to active.... so here goes:

I called BCBS and the lady told me that you had to have six months documented weight loss attempts within the past 24 months to be considered for surgery.  These did not have to be consecutive.

My surgeon told me today that they were told within the past 12 months.

Do you know where I can find the official policy?  Or, can you tell me what you were told (recently).  Know the policy has changed, and will change again on Sept 1st.

When I tried to "google it" all I could find was out of date information.

Thanks in advance.
 Come to the Dark Side!!!                     
Band to DS revision 11/09/09.
Learn about the Duodenal Switch at dsfacts.com ! Off site comparisons of the 4 WLS 
http://www.thinnertimes.com/weight-loss-surgery/wls-basics/w eight-loss-surgery-comparison.html
http://www.lapsf.com/weight-loss-surgeries.html
 
  
Poodles
on 7/28/11 9:24 am - TX
This is what I found on the policy for BCBSTX, but does not say TRS.  Do you think it would be the same?
 
2.  Evidence that comprehensive non-surgical treatment of morbid obesity has been attempted prior to surgical treatment of morbid obesity: 
  • Documentation of active participation in a comprehensive, non-surgical program of weight reduction for at least six (6) months, occurring within the twenty-four (24) months prior to the proposed surgery.  
  • NOTE: The initial BMI at the beginning of a weight reduction program will be used to meet the BMI criteria for the definition of morbid obesity used in this policy.
  • A program will be considered appropriate if it includes ALL of the following components:
    1. Nutrition program, which may include a very low calorie diet or a recognized commercial diet-based weight loss program; AND
    2. Behavior modification or behavioral health interventions; AND
    3. Counseling and instruction on exercise and increased physical activity; AND
    4. Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health; AND
3.  Documentation from prospective surgical program for the treatment of morbid obesity
 
 
Source:
 
http://medicalpolicy.hcsc.net/medicalpolicy/home?ctype=POLIC Y&cat=Surgery&path=/templatedata/medpolicies/POLICY/data/SUR GERY/SUR716.003_2011-03-15#hlink
 
 Come to the Dark Side!!!                     
Band to DS revision 11/09/09.
Learn about the Duodenal Switch at dsfacts.com ! Off site comparisons of the 4 WLS 
http://www.thinnertimes.com/weight-loss-surgery/wls-basics/w eight-loss-surgery-comparison.html
http://www.lapsf.com/weight-loss-surgeries.html
 
  
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