Insurance in Texas !

[amandap120312 0]

Greetings ! My name is Amanda. I am inquiring about WLS however, my insurance company (Cigna) has an exclusion to Bariatric Surgery. With this being sad I am pretty sure that they won't cover it even with medical letters and such? (right or wrong?) please correct me. So my next questions are should I change insurance companies? I see that some have BCBSTX or United Health Care and it's covered with of course evaluations and such. Would my best bet be to get an individual plan with the coverage or to try to save up as much as possible in the next year or so to do self pay? I've been researching for the past few months about weight loss surgeries and I feel it would be the best bet for me. I meet with a surgeon for a general consult on Dec 4th. Maybe he will be able to give insight? I don't want to get discouraged but the entire medical insurance in Texas is blowing my mind. Any good feedback would be great. Thanks for reading.

-Amanda

[ladycook9713 442]

It's not Cigna that is choosing not to cover it. It's your employer. Employers get to choose what is and not covered on the health plans that they offer to their employees. Your best bet is to write to your HR/Benefits department to encourage them to add this benefit to all employees health plans explaining the benefits it would provide to them as a company. If you do a google search there are example letters out there. If your insurance is not through an employer and is privately based then that particular plan has the exclusion and you would have to find a different plan that has that benefit on it, which could have a higher premium to it.

[amandap120312 0]

Ok ! Thanks. I will get on that letter. I have a consult with a Surgeon next week. Any tips?

-Amanda

[Tobeornottobe 89]

Is your insurance through your job? All insurance companies offer bariatric surgery, however, its not considered a medical necessity so employers can opt out. If your insurance is through your employer, the other plans offered may have the same exclusion with BCBS and United Healthcare.

Greetings ! My name is Amanda. I am inquiring about WLS however, my insurance company (Cigna) has an exclusion to Bariatric Surgery. With this being sad I am pretty sure that they won't cover it even with medical letters and such? (right or wrong?) please correct me. So my next questions are should I change insurance companies? I see that some have BCBSTX or United Health Care and it's covered with of course evaluations and such. Would my best bet be to get an individual plan with the coverage or to try to save up as much as possible in the next year or so to do self pay? I've been researching for the past few months about weight loss surgeries and I feel it would be the best bet for me. I meet with a surgeon for a general consult on Dec 4th. Maybe he will be able to give insight? I don't want to get discouraged but the entire medical insurance in Texas is blowing my mind. Any good feedback would be great. Thanks for reading.


-Amanda

[beckyrow 18]

I coordinate health insurance for our company and every one I looked at excluded bariatric surgery. My insurance agent told me that Texas still hasn't determined that bariatric surgery is medically necessary, so insurance companies don't have to cover it. Contrary to the post above, it's probably not your employer excluding it. My doctor said Humana and BCBSTX were the worst at trying to get approval. Some other insurance companies will approve you after you jump through some hoops. Good luck!

[rking 484]

I am in texas and have Aetna. I did jump through some hoops and it all turned out well. I am 18 days post op.

[amandap120312 0]

I need to find out what are these hoops so I can jump too! Congrats ! How are you feeling

[rking 484]

I was completely overwhelmed with them at first but my doc office was sooooo good and they know exactly what Aetna needed to know and knew exactly how to write it. I chose the 90 day protocol to "get yourself ready for surgery" option.

1. 4 nutritionist visits. I did mine over the phone with nutritionist they recommend cuz I am five hours away. She knows exactly what insurance needs. $40 a visit.

2. Cardiologist clearance. Did a sonogram on heart and stress test. No big deal. He had to write a letter.

3. Exercise program supervised by qualified person. Nutritionist counted for this since you do discuss in detail your exercise that you are doing. You have to workout or walk or something.

4. Psych evaluation. Got that done no biggie.

5. Doctor has to say you are in this pre surgery regimen.

6. You CANNOT gain any weight during this 90 days.

Also, if your BMI is between 35-40 you must have a co morbidity. High blood pressure has to be really really bad to qualify.

Let me know if you have questions.

[Tobeornottobe 89]

I coordinate health insurance for our company and every one I looked at excluded bariatric surgery. My insurance agent told me that Texas still hasn't determined that bariatric surgery is medically necessary, so insurance companies don't have to cover it. Contrary to the post above, it's probably not your employer excluding it. My doctor said Humana and BCBSTX were the worst at trying to get approval. Some other insurance companies will approve you after you jump through some hoops. Good luck!

I work in health insurance. I can assure you it's offered as an option and it's up to the employer as to whether or not they choose to carry the option. There are other people in Texas who are having bariatric surgery and it's covered through plans provided by their employers.

If the health insurance is through an exchange it may be a different story.

[rking 484]

Mine is through employer.