Blue Cross Blue Shield of Texas?

[heartonmysleeve82 11]

@@Teebaby that is awesome! I got my approval on Friday but awaiting my letter to come in the mail. I am hoping for a date the 2nd week in May *fingers crossed*

[Teebaby 27]

You go Girl! Congrats!!! This is going to be the best summer ever!!!

[heartonmysleeve82 11]

I am still waiting on my letter to come in the mail. How long did it take before you received yours? @@Teebaby

[Teebaby 27]

@@heartonmysleeve82 I was approved in 3 days but I didn't get my letter until 7 days after submission

[spiritfilled 32]

I also have BCBS of TX and received this after inquiring if my insurance covered it.( see below ) I only have a BMI of 38.4. I could gain less than 10 lbs and have a BMI of 40.1 which I do not want to do at all. I am thinking will will be covered under high cholesterol, arthritis in my back and or sleep apnea.

Surgical treatment of morbid obesity may be considered eligible for coverage when all of the physical, clinical and psychological indications are documented according to Blue Cross Blue Shield of Texas current medical policy. A letter of support and/or explanation is helpful but alone will not be considered sufficient documentation to make a medical necessity determination.

We are not in a position to consider the request for surgical treatment of morbid obesity due to the lack of available medical documentation to determine medical necessity based on Blue Cross Blue Shield of Texas medical policy. The following documented clinical information is necessary for further review.

For a member to be considered eligible for benefit coverage of bariatric surgery to treat morbid obesity, the member must meet the following two criteria:

1. Diagnosis of morbid obesity, defined as a:
- Body mass index (BMI) equal to or greater than 40 kg/meter (* see guidelines below for BMI calculation); OR
- BMI equal to or greater than 35kg/meters with at least two (2) of the following comorbid conditions related to obesity that have not responded to maximum medical management and that are generally expected to be reversed or improved by bariatric treatment:

o Hypertension, OR
o Dyslipidemia, OR
o Diabetes mellitus, OR
o Coronary heart disease, OR
o sleep apnea, OR
o Osteoarthritis; AND

2. Documentation from the requesting surgical program that:
- Growth is completed (generally, growth is considered completed by 18 years of age); AND
- Documentation from the surgeon attesting that the patient has been educated in and understands the post-operative regimen, which should include ALL of the following components:

1. Nutrition program, which may include a very low calorie diet or a recognized commercial diet-based weight loss program; AND
2. Behavior modification or behavioral health interventions; AND
3. Counseling and instruction on exercise and increased physical activity; AND
4. Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health; AND
- Patient has completed an evaluation by a licensed professional counselor, psychologist or psychiatrist within the 12 months preceding the request for surgery. This evaluation should document:
1. The absence of significant psychopathology that would hinder the ability of an individual to understand the procedure and comply with medical/surgical recommendations, AND
2. The absence of any psychological comorbidity that could contribute to weight mismanagement or a diagnosed eating disorder, AND
3. The patient's willingness to comply with preoperative and postoperative treatment plans.

The member and their physician(s) are urged to review the full text of the Blue Cross Blue Shield Texas (BCBSTX) medical policy on this subject on the BCBSTX Website at www.bcbstx.com. Choose the "provider" link at the top of the Website and select Medical Policy under the Standards and Requirements tab. You may need to click I Agree to the terms page to be directed to the Medical Policy. Once on the Medical Policy page you will need to click on Active and Pending Medical Policies. You can use the search box and search for Surgery for Morbid Obesity or Bariatric Surgery.

If you have any further questions or concerns, please contact our customer service department at the toll-free number on the back of your Blue Cross Blue Shield identification card or via the Message Center on Blue Access for Members.

[vsgval 13]

That's awesome, I hope mine happens that fast...I have BCBS of Texas also, they received mine on 3/30 so I am just waiting. I pray everything goes well for you!!!!

Did you ever get approved?

[heartonmysleeve82 11]

YES I GOT APPROVED AND MY SURGERY DATE IS 5/18

NOW I AM JUST WONDERING HOW MUCH OUT OF POCKET I WILL HAVE TO PAY. I PAY 30% OF WHATEVER THE COST IS I THINK WITH MY INSURANCE. HOPEFULLY IT DIDNT BLOW MY MIND....