BCBS HealthSelect State of Texas Employees

[onmywaytoskinny 0]

OK. BCBS will start covering WLS starting September 2010. You will find the details on ERS website. In short, you will have to pay $5000 deductible and 20% co-insurance. I am not clear on all the requirements because they wrote it kind of funny! I have started what we (dr. and I ) think the requirement are and hopefully I can submitted everything on September 2nd. It looks like even with insurance I will have to pay $8,000 out of my pocket. WOW! :thumbup:

[Tahnni44 0]

I have this same insurance and called to get some specifics. I have my notes at work, so from memory..I was told ..there was a 12 month medically supervised pre surgery diet requirement. Only 1 surgery per lifetime. Only the actual employee is eligible...no spouses, dependents etc. I think 2 existing co-morbidities. You have to stay on an approved/supervised diet after surgery for 12 months...and it seems like there were some other things. Those were the major ones I remember though. With the 5k special deductible and the 80/20 after that is met..along with the 12 months pre-diet and post diet requirements, I am wondering if self pay may be cheaper and that way IF anything does go wrong I would have the insurance to pay for any type of revision if needed. I also don't want to wait 12 more months The guy I talked to at BC/BS said more information would be coming out prior to summer enrollment and that starts in July.

Also, I was planning on using True Results in Houston. They do the surgery in their facility as a day surgery from what I was told. At that time I was told that some insurance companies require a hospital setting and overnight stay. If BC/BS does end up requiring this..it would run up the cost of the surgery alot it seems.