BCBS TRS insurance.....anyone?

[Texasmom65 23]

I went for my first consult last week for the Gastric sleeve. My insurance is with BCBS of Texas TRS. Starting September they have a $5000 copay for any weight loss surgery. That is crazy. Anyone else have this insurance?

Robin

[MeMeMEEE 206]

whoa!! very scary! Do you have to do the 6 months of supervised weight loss? Or can you get sleeved before September? Glad they were able to tell you this far out to expect that though.

[Texasmom65 23]

whoa!! very scary! Do you have to do the 6 months of supervised weight loss? Or can you get sleeved before September? Glad they were able to tell you this far out to expect that though.

I have to do the 6 month supervised weight loss. But it doesn't have to be consecative. Just within the last 24 months. So I know I have with my doctor, just not sure if it all falls in the 24 mo. period. I'm also on weight watchers since early March.

Would be nice if it would all qualify, but not banking on it.

Robin

[MeMeMEEE 206]

oh I hope so!! I have BCBS of IL (I work for Health Care Service Corp which is BCBS of IL, TX, NM and OK) and I know the med policy reads that way but for some reason my surgeon's program will only submit once they have 6 consecutive - I will look forward to hearing if they approve you - maybe I can go to my program and ask them to try - I had one month (January) where I didn't see the Dr so that makes me not consecutive - BOO!

[Texasmom65 23]

oh I hope so!! I have BCBS of IL (I work for Health Care Service Corp which is BCBS of IL, TX, NM and OK) and I know the med policy reads that way but for some reason my surgeon's program will only submit once they have 6 consecutive - I will look forward to hearing if they approve you - maybe I can go to my program and ask them to try - I had one month (January) where I didn't see the Dr so that makes me not consecutive - BOO!

Oh that does suck you have to start all over just for one month.

Oh a BCBS employee :-) I am Billing manager for a group of physician in Texas. Oh gotta love BCBS. LOL Actually they are one of the best insuarnces out there to work with.

Robin

[MeMeMEEE 206]

LOL glad to hear it - I am an International Claims Examiner so I work in Blue Card and do claims for all four states from members who had a claim internationally. Always interesting for sure. I am a little freaked about that $5000 copay but I know many groups have their own rules so maybe it isn't corporate - and hopefully if it is I will be sleeved before then! hehe! Good luck to you as well - hope you have those 6 visits within 24 months that you need!!

[LissyinTX 1]

I have the same insurance. I recently got the book with all of the info if I wanted to change my plans. I wish you luck with everything and the insurance. I am going through the VA, but a friend went through BCBS TRS and she had to do the 6 month consecutive and a mental eval. I would do more research on what the costs are, I thought I read it would end up being around 8 after all copays etc.

[Texasmom65 23]

I have the same insurance. I recently got the book with all of the info if I wanted to change my plans. I wish you luck with everything and the insurance. I am going through the VA, but a friend went through BCBS TRS and she had to do the 6 month consecutive and a mental eval. I would do more research on what the costs are, I thought I read it would end up being around 8 after all copays etc.

The good thing is since they will be filing my insurance, even if its just to go toward my copay/deductible, they can only bill me the contracted rate. And I've check with BCBS and the contracted rate for the surgeon is just under $2000. So I'm good there. It's the facility fee that will cost the most.

[LissyinTX 1]

Cool deal. i hope it all works out for you in the end.

[2buster 0]

Hello Everyone,

I've been reading these boards for quite some time now and finally decided to register. I'm in Houston with BCBS and there is a 5,000 deductible/copay for me also. I was received my approval letter from BCBS for gastric sleeve 4/29 (so excited). Waiting on MD to call regarding surgery date. All requirements have been met. Everyone here is so nice and I have obtained so much information. Good luck to all!

[Phat girl 6]

Hi,

I have bcbs trs and started weight watchers 3/10/2011. I attended 6 months of ww. I saw my doctor 4 times, did the psych eval and saw a nutrionist once. I was approved at the beginning of august and will be having the gs next week. I was denied at first but I fought with them. Look at your trs medical policy. It does NOT have to be consecutive months. And weight watchers does count because it is a "commercial weight loss program". You will have to call yourself because the insurance coordinators at the doctors offices are only interested in coordinating the doctors money.