Any Texas teachers use our health insurance? How much did you pay out of pocket?

 I am a teacher in Texas and am not currently on my employer's plan. I was researching it, though, and was crunching the numbers and was amazed at how much I will pay out of pocket. There will be a $5000 co-pay (which doesn't go toward deductible or the out of pocket maximum), $150 co-pay per day for the hospital (plus 20% after deductible), $750 deductible and then another 20% for "other covered services" (assistant surgeon, anesthesia, other professional services, etc.). If I'm calculating correctly, it appears that I will be paying $8200 out of pocket.  Admittedly, this is cheaper than self-pay (which is around $12,500 in my area), but yikes!!!!

I was just wondering if any Texas teachers had gone through our insurance and how much you ended up having to pay out of pocket.  My husband's insurance does not cover bariatric surgery at all.

Also--did you have trouble getting approved for the sleeve if your bmi was lower than 40? I think mine is around 36 or 37 and I don't have any co-morbidities of which I know. Do doctors find a way to make that work?  

Did you have any waiting period (like 6 months of a supervised diet?)

I was looking at the TRS Active Care 2 plan (BCBS of TX).

Thanks so much for your help!

Pam :)

I don't know anything about TX, but from what i've heard it's pretty hard to get insurance to cover if ur BMI is less than 40 without a co-morbidity... I know quite a few ppl on here have gone to Mexico for surgery and the numbers I've seen are around $8000 I believe... maybe sum of them will chime in, but it may be an option to look into and not even worry with insurance, if ur gonna pay that much out of pocket anyways... Good luck and I hope u get sum more feed back!

I am too in education and on Active Care 2.  I am 5'4 199 BMI 35 and I have type 2 diabetes.  TRS changed as of Sept. 1.  No more 6 month waiting period.  If you have a BMI of 35 of higher with other comorbedities like Diabetes you can be approved.  However, besides the 750 deductible and 2,000 out of pocket max they have a separate copay of 5,000 for weight surgery.  If you do not have comorbedities you have to have BMI of 40 or higher.  I am going through all the process now.  I have my psych evaluation during spring break and should be set to go for surgery in June.  I am having hysto in May.  This will help expenses some since I will have already met my out of pocket max.  I will still have to pay the 5,000 wls copay.  I have recently spoken with our insurance to get all this explained to me.

Awesome! This is good to know! Do you have two co-morbidities? I was looking on the website and it said that we have to have 2. That's good about not having the 6 month waiting period.

Thanks so much!!

i have trs active care and i paid a little over 2,000. part of it was due to a longer than expected hospital stay.  Unfortunately, the new $5000 for bariatric surgeon is part of every plan now.  I would have the surgery again if it helps in your decision.

I am an educator in Texas and my district has BCBS insurance.  There is a added exclusion in our policy that states they will NOT pay for any weight loss surgery even if it was caused or causing other health issues.  So I had to self pay to have my surgery.  I know it is a lot of money, but I don't regret it one bit.  I have lost 36 lbs. in 5 weeks and I only look forward to the weeks and months to come!  It's hot in Texas and can't wait to lay in my pool this summer with a new confidence about myself!!!!

Amen to that! I, too, would love to hang out by the pool with a lot fewer pounds!! :)

 I am on BCBS Texas, and a teacher! I was just approved. By BMI is right at 40 with no co morbidities. I am 29 and 5'5. 
Dr.Nicholson is Wonderful! He is in Plano and only makes teachers pay 2,000 of the 5,000 co-pay! 

I am on TRS active care one because there really is no difference in one and two, besides not having to pay anything monthly for active care 1! 

My deductible is 1,200 and I have already meet that. So, I will be paying about 3,000!!! 

Once deductible is meet, I have to pay 20% with a 2,000 out of pocket max! 

Hope this helps!

OHhh, I was Approved in one week. 

Thanks Amber! I am meeting with Dr. Nicholson in 2 weeks! I can't wait! If they truly think that bcbs will approve the sleeve-then I will get on my teacher insurance. That means I won't be able to have a summer surgery since I won't be on the plan until September 1. But if it will save me thousands of dollars-it's worth the wait.

If I don't change to my insurance, then I will be self-pay. My bmi is 36 and I don't know of any co-morbidities other than a slightly elevated cholesterol level. 

Yea for being approved in 1 week!!!

 I just wrote you a PM on how the insurance works....but, I just saw your BMI.....they won't pay if your BMI is not at least 40 without any co-morbiditeis......they will approve 35 and above but you have to have a co-morbidity....... they could change this by then, who knows!