Bluecross Blueshield Of Texas

[Smiley79 13]

Hi!

Anyone use Blue Cross Blue Shield of Texas, Health Select to cover the cost of their surgery? I am on my husband's insurance plan and need to know if it will cover the cost of me having this surgery. If it doesn't cover the cost, I will have to be a self-pay.

I'm a newbie in North East Texas just starting the process. Any help is appreciated! Thanks!

[tarakuk 6]

I habe BCBS of Minnesota, which doesn't help you at all....but call the customer service number on the back of your card and ask if they cover weight loss surgery. They should be able to tell you everything they cover and if you need a 6 month doctor supervised weight loss plan first. Hope this helps!

[MyGastricSleeveLife 180]

BCBS has so many different plans - that even have the same names - so you need to just call & ask. My husband works for a tiny company & we have BCBS Texas (not Health Select though) & they told us there is a bariatric surgery rider that the company could add on to the policy, but his company didn't choose it, so I was self-pay. Again, there are tons of different plans even through BCBS & different companies even if someone else has Health Select, so it's best to just call them. Some plans that do cover bariatric surgery only cover the lapband or bypass & not the sleeve too, so it's best to call & see what they say is covered & what hoops you have to jump through to get approval if they do cover it.

[Smiley79 13]

Thanks so much for the information ladies! I will call the number on the back of the card. Thanks again for your help.

[Smiley79 13]

Copied & Pasted from the BCBS of Texas - Health Select/ERS Website:

http://www.bcbstx.com/hs/bariatric_surgery.html

Bariatric surgery is also commonly known as weight-loss surgery. To qualify for bariatric surgery coverage, you must meet all the requirements listed below.

Checklist of Requirements:

• You must be an active employee or a return-to-work retiree* with five continuous years of Texas Employees Group Benefits Program (GBP) employment with no breaks in G.B.P. coverage. No breaks in coverage can include years of coverage with an H.M.O. in the G.B.P. ****The benefit is not available to dependents, retirees not enrolled in active employee benefits, or H.M.O. members, even if they have other insurance that covers bariatric surgery, such as Medicare.
  

• You must undergo one of the covered bariatric surgical procedures at a Blue Distinction Center for Bariatric Surgery^®.
  

• You must have at least one other condition considered a co-morbidity, uncontrolled at maximum medical management, and which is generally expected to be reversed or improved by bariatric treatment to include, but not limited to:
  
  • Diabetes;
    
  • Hypertension;
    
  • sleep apnea;
    
  • Dyslipidemia;
    
  • Coronary heart disease;
    
  • Osteoarthritis; or
    
  • Any other co-morbidity related to obesity that has not responded to maximum medical management and that is generally expected to be reversed or improved by bariatric treatment.
    

• You must have been evaluated by a licensed professional counselor, psychologist, or psychiatrist within the 12 months before the request for predetermination of benefits.
  

• You must have medical records documenting a five-year history of Body Mass Index (BMI) greater than or equal to 40.
  

• You must have documented active participation in a comprehensive, non-surgical weight reduction program (for example, the BCBSTX weight management program) for at least 12 consecutive months during the 24 months before the date you apply for surgery.
  

• After surgery, you must provide documentation that you have participated in a medically supervised lifestyle management program for maintaining weight loss and health goals (such as the BCBSTX weight management program) for 12 consecutive months after the date of surgery.
  

If you have questions about bariatric surgery coverage or benefits, contact Blue Cross and Blue Shield of Texas (BCBSTX) at (800) 252-8039.

Edited July 26, 2012 by Smiley79

[tarakuk 6]

That's a pretty harsh plan. So I guess you're a dependant since your husband carries the policy, which means they won't cover it?

[funkeechiggen 135]

Also, how would they enforce the post-op 12-month support meetings?! Don't see how they can require that once they approve the surgery. Clearing you for surgery implies BCBS agrees to pay the surgeon/hospital their portion of the fees. Are they going to demand their money back from the surgeon if you don't attend post-op!? Force you to pay them back!? Very strange!

What a pain in the rump! :/. In your situation sounds like self-pay is the way to go!

[Smiley79 13]

That's a pretty harsh plan. So I guess you're a dependant since your husband carries the policy, which means they won't cover it?

Yep, unfortunately. So self-pay it is. Still researching different surgeons.

[IMSKINNY 160]

Although it sounds stringent, it sounds like what we all had to do and that is prove that it is medically necessary. A good surgeon's office helps you meet their criteria. If your BMI is 40 or above, then go to a surgeon with full service operation and try. If not, Mexico is a great, low cost option.

[IMSKINNY 160]

How do they get away with excluding dependents? Geez!

[iggychic 1,405]

Every state has different laws in regards to coverage, then on top of that every employer can vary. I have bcbs and it will not cover my surgery because I don't have any comorbidity issues and my bmi is 36. Next year our plan will cover a bmi over 35 without comorbidity issues because we will change our rider to do so (we own the company). But we would still expect a five year history, psyc, etc. in our state we can't reduce the policy for dependents (which is rediculous) nor require a certain period of employment for specific benefits. That's kind of bizzare IMO but you are the Rick perry state .