Bcbs tx

Lovely Lo · November 24, 2010

Hello all I haven't posted any questions on here but I have been reading for several months!! My paper work was submitted to my insurance, and I find out that they didn't approve it because I have to have 12 months of attempted weight loss but the dr who was going to do the vsg said bcbs only requires 3 months. So now I'm sad I was hoping to be scheduling my surgery. I've had an active membership at curves for 14 months and a 6 month doctor supervised diet so is there not anyway for my 14 months of working out to be my proof of attempted weight loss? Or do I have to do another 6 months of dieting and waiting? Any advice would help!!

TexasTeacher · November 25, 2010

I'm so sorry, Lovely! Have you talked with them about resubmitting? Stay on them about getting it done, there's still hope for us to be in at the same time!

Lovely Lo · November 28, 2010

I'm so sorry, Lovely! Have you talked with them about resubmitting? Stay on them about getting it done, there's still hope for us to be in at the same time!

Aww I know... I see my pcp Monday so hopefully she'll help me out!! I'm going to try to talk with someone at Dr. Barker's office too!! Praying hard for some good news!!!

dbrjredd · November 28, 2010

Hello all I haven't posted any questions on here but I have been reading for several months!! My paper work was submitted to my insurance, and I find out that they didn't approve it because I have to have 12 months of attempted weight loss but the dr who was going to do the vsg said bcbs only requires 3 months. So now I'm sad I was hoping to be scheduling my surgery. I've had an active membership at curves for 14 months and a 6 month doctor supervised diet so is there not anyway for my 14 months of working out to be my proof of attempted weight loss? Or do I have to do another 6 months of dieting and waiting? Any advice would help!!

Lovely Lo,

I have BCBS TRS Active Care of TX & I only had to do 3 mths of weight loss classes & show where I'd attempted weight loss over the years! I know every insurance is different but I wouldn't give up...that's what they're hoping you'll do! Keep calling & asking questions...whatever you have to do to get it done. I was sleeved on Nov 18 & I am already glad I did it! Good luck & don't give up!

PlannerGirl · November 28, 2010

Your 14 months at Curves should show attempted weight loss. The good news is, every time you go to curves you check in with the key card and they keep a record. I would suggest asking the team at your Curves to give you some sort of print out of your attendance. I would also ask for your weigh in and measurement info.

If you have been watching your diet during this period, I would write a detailed description of what you've done. Thing is......they say you have to attempted weight loss, it doesn't say you had to be successful at it.

Lastly, is your insurance through your work, perhaps a large company. If it is, check to see if your company has a claims advocacy department. Copy them on all correspondence with BCBS.

When I applied through my insurance, I was missing some information, but I made up for it with a lot of additional documentation and got approved on the first try. I wrote what I believe were some fairly persuasive letters which I would be happy to share with you and you can tailor it to your situation.

Helping folks get approved for this surgery is sort of a new life mission for me. It frustrates me immensely when the insurance companies jack around with peoples lives like this just because they can. The co-ordinator at my doc's office has asked me to help a few folks there. With some strong words and some tenacity you can get this done. If you need help, let me know.

Lovely Lo · November 29, 2010

Your 14 months at Curves should show attempted weight loss. The good news is, every time you go to curves you check in with the key card and they keep a record. I would suggest asking the team at your Curves to give you some sort of print out of your attendance. I would also ask for your weigh in and measurement info.

If you have been watching your diet during this period, I would write a detailed description of what you've done. Thing is......they say you have to attempted weight loss, it doesn't say you had to be successful at it.

Lastly, is your insurance through your work, perhaps a large company. If it is, check to see if your company has a claims advocacy department. Copy them on all correspondence with BCBS.

When I applied through my insurance, I was missing some information, but I made up for it with a lot of additional documentation and got approved on the first try. I wrote what I believe were some fairly persuasive letters which I would be happy to share with you and you can tailor it to your situation.

Helping folks get approved for this surgery is sort of a new life mission for me. It frustrates me immensely when the insurance companies jack around with peoples lives like this just because they can. The co-ordinator at my doc's office has asked me to help a few folks there. With some strong words and some tenacity you can get this done. If you need help, let me know.

Your 14 months at Curves should show attempted weight loss. The good news is, every time you go to curves you check in with the key card and they keep a record. I would suggest asking the team at your Curves to give you some sort of print out of your attendance. I would also ask for your weigh in and measurement info.

Thank you so much anything you can give to help me out would be greatly appreciated!! I've been looking into wls since I was 16 thought I wanted a band but now at 22 the sleeve sounds like the perfect tool for life!! I do have my weight and measurements thru curves but I don't use the Id card because that was more expensive monthly now I wish I had!! The insurance is thru my husband. My email is lauren.brittneyy@yahoo.com anything you think would help me I would love to have and thanks so much for taking the time to read my entry.

Lovely Lo · November 29, 2010

Your 14 months at Curves should show attempted weight loss. The good news is, every time you go to curves you check in with the key card and they keep a record. I would suggest asking the team at your Curves to give you some sort of print out of your attendance. I would also ask for your weigh in and measurement info.

If you have been watching your diet during this period, I would write a detailed description of what you've done. Thing is......they say you have to attempted weight loss, it doesn't say you had to be successful at it.

Lastly, is your insurance through your work, perhaps a large company. If it is, check to see if your company has a claims advocacy department. Copy them on all correspondence with BCBS.

When I applied through my insurance, I was missing some information, but I made up for it with a lot of additional documentation and got approved on the first try. I wrote what I believe were some fairly persuasive letters which I would be happy to share with you and you can tailor it to your situation.

Helping folks get approved for this surgery is sort of a new life mission for me. It frustrates me immensely when the insurance companies jack around with peoples lives like this just because they can. The co-ordinator at my doc's office has asked me to help a few folks there. With some strong words and some tenacity you can get this done. If you need help, let me know.

Your 14 months at Curves should show attempted weight loss. The good news is, every time you go to curves you check in with the key card and they keep a record. I would suggest asking the team at your Curves to give you some sort of print out of your attendance. I would also ask for your weigh in and measurement info.

Thank you so much anything you can give to help me out would be greatly appreciated!! I've been looking into wls since I was 16 thought I wanted a band but now at 22 the sleeve sounds like the perfect tool for life!! I do have my weight and measurements thru curves but I don't use the Id card because that was more expensive monthly now I wish I had!! The insurance is thru my husband. My email is lauren.brittneyy@yahoo.com anything you think would help me I would love to have and thanks so much for taking the time to read my entry.

weightnomore · December 6, 2010

Hello all I haven't posted any questions on here but I have been reading for several months!! My paper work was submitted to my insurance, and I find out that they didn't approve it because I have to have 12 months of attempted weight loss but the dr who was going to do the vsg said bcbs only requires 3 months. So now I'm sad I was hoping to be scheduling my surgery. I've had an active membership at curves for 14 months and a 6 month doctor supervised diet so is there not anyway for my 14 months of working out to be my proof of attempted weight loss? Or do I have to do another 6 months of dieting and waiting? Any advice would help!!

BCBS of Texas is my insurance. They have their clinical policy bulletin right online if you know where to look. One of the women in the benefits office showed me how to find it. There policy is for a THREE month supervised weight loss. That is what I did and I got approved without a problem. (They just started allowing the sleeve in July 2010, BTW)

Here is a link so you can read it yourself: http://medicalpolicy.hcsc.net/medicalpolicy/home?corpEntCd=TX1&path=/templatedata/medpolicies/POLICY/data/SURGERY/SUR716.003_2010-07-01&ctype=POLICY&cat=Surgery#hlink

I don't know why your requirement should be any different. If I were you I would call them and quote the above to them and see what they say.