Desparated in Bmt.TX

[casb37 0]

:help: Does anyone know of an indivdual insurance in Texas that pays for the lapband sugery. I currently have BC/BS ofTexas thru employmentand they will not pay for this procedure. I have tried various ways but have come up with nothing. If anyone has any insight of how can get started please answer back. Thanks new member casb37.

[Carlene 12]

Individual medical policies are, unfortunately, the least likely to pay for weight loss surgery.

If you are really desperate, you might try job shopping for a position that has insurance that doesn't exclude WLS.

When my (now late) husband became too ill to work and lost his insurance, that's what I did. I resigned from a job I loved and had held for 15 years because the insurance required a 12 month no-coverage period for pre-existing conditions.

[Kat817 19]

We too have BCBS of TX. Our policy does cover WLS. There were 3 issues that had to be met, and there were no variations on those issues we found. #1. you had to have a BMI of at least 40 or be 100 lbs. over your ideal weight, and have medical documentation that you have had this for 5 years or longer. #2. You had to have minimally 2 co-morbidities, ie. Hypertension, diabetes, sleep apnea, etc. And #3. You must have 12 consecutive months within the last 24 months of Physician supervised weight loss efforts, including but not limited to bi-monthly nutritionist consults, and a medically designed exercise program.

I qualified the first 2 no problem. #3 hung me out to dry tho. I had records of weight loss attempts, receipts from weight loss centers, etc. but they were not being medically supervised. And I had not had any formal nutrition counseling. I was denied, appealed and denied again. Chose not to throw good money away hiring an attorney and fighting it. Instead we opted for me to have my surgery in Mexico. We are using the settlement I received from a car accident I was injured in to pay for it. We fly out early Sunday morning, surgery Monday...I am SOOOO excited!!!

Good Luck to you, I hope you find a way to make it happen!

Kat

[legallyKristin 0]

Even then BCBS TX may not cover lapband. I had all of the pre-requisites but the actual EMPLOYER that provides the insurance may have excluded certain coverage. I could have had RNY and it would have been covered, but lapband was a big NO.

Good luck!

:bananadoggywow: Kristin

[Moserd 0]

Hi, sounds like your doing great. Im considering the surgery, did you have any bad side effects?

[legallyKristin 0]

Not a one! Except for the fact that my old clothes don't fit!

:grouphug: Kristin

[Moserd 0]

Thanks so much...keep ur fingers crossed for me!

[legallyKristin 0]

Of course! Good luck!

Kristin

[Lady06 0]

I to have bcbs, and didn't qualified, so I took it south to monterrey mx. had my surgery last wed doing great! every thing went wonderful. I am from PA

[fosterc 0]

I'm Sorry to hear that BC BS of texas didn't pay for ya'lls. my husband has it and he qualified with no problems. it only took a few months. my on the other hand took over 12 months, I have Aetna. they seem to be very picky. Keep trying and good luck.

Fosterc

[legallyKristin 0]

It all depends on the employer. They can opt out. It sucks.

Kristin