Bcbs of Texas won't approve

[nerdmom 4]

We spoke to bcbstx and they will not approve me under any circumstances bc it is not a covered benefit. Went through the psych eval UGI and all my clearances and got denied. Even though the surgeons office called to confirm it was a benefit in feb. Can't appeal as bcbs told us the won't accept an appeal at all. Soooo here I go self pay. Taking my down payment tomorrow. This sucks. What the heck am I paying $800 a month to bcbs for then?

[Daisee68 2,493]

Oh wow! I am so sorry! That is awful. Have you called them yourself? I know there is a written appeal process for most insurance companies. Have you tried that? While it is supposedly covered under my plan, Cigna has been very difficult approving other things, so I fear in the end they will decline as well.

Oops. just saw you already mentioned the appeal. Really so sorry...

[nerdmom 4]

Yup we called bcbs ourselves. I don't know if it has to do with the fact that we have a ppo. We are self employed and pay everything on out of our own pocket. This just sucks. Thanks though. Luckily I can still get it but it sucks to have to pay it all out of pocket.

[vanessak8 158]

You should be able to tell from your policy if it's covered or not. I would start there...

[nerdmom 4]

It states yes on the Internet on our policy and excludes it on our explanation of benefits.

[vanessak8 158]

Maybe it's that blue cross blue shield of Texas generally covers bariatric surgery, but the policy that your employer purchases through them does not. Ultimately it is your employer that picks what your policy covers and what it does not.

Edited March 13, 2015 by vanessak8

[nerdmom 4]

We are self employed with the gold standard policy.