BCBS Texas

sandahlia · August 17, 2007

Hi does anyone have BCBS of Texas? I was wondering what your experience has been with them.

amethystlady · August 18, 2007

i have bcbs of texas and in my employee handbook it states they will not cover any type of wls. i've heard from so many people from this forum and others stating it's a good chance when they say no, it's no; i've also been told to go to my human resource dept. and speak with someone over benefits and see if the non-coverage can be overridden because of my health concerns (of course with all my physicians paperwork); was told to continue to have a letters of neccesity sent by my physician (s)to bcbs and if denied, appeal, appeal, appeal. and lastly, get a obesity advocy (sp) lawyer if necessary. i've read of a few on this forum and another who care and will help for almost next to nothing. so, knowing all of this, i will continue to see my pcp, let her know what i'm planning, have all the steps needed before i get lapband documented if and when i do get o.k'd. i will continue to fight.

ragdollx19 · August 18, 2007

BCBS of Texas like other insurances is individual to your employers policy. They have the option to place an exclusion on their policy for all WLS procedures which saves them money. Google "cpt code lap band" call your insurance company's 800 # and ask them if that cpt code is covered on your policy. If they say it ISW covered ask them where in your insurance book the information related to this surgery is so that you can see what if any hoops they may require you to jump through.

If they say there is an exclusion I believe you will have to find other ways of paying for the surgery but I am no expert.

Good Luck!

sandahlia · August 19, 2007

Thanks for your reply. I found out that my policy will cover surgery if it's medically necessary. I guess what I would like to find out now is what anyone's experience has been with BCBS Texas in getting approved (provided they have coverage for surgery.) Was it a long process that required jumping through hoops? Also, my BMI is 37 with some comorbid conditions, I'm wondering if they make it difficult to get approved with a lower BMI.

ragdollx19 · August 20, 2007

I have BCBS Texas Federal and had a bmi of 42, 40 seems to be the magic cut off with no comorbids. My paperwork was submited on a thursday and I was approved by monday or tuesday.

Your physicians office should be able to help you out with all of this. When do you go for your first appointment?

sandahlia · August 20, 2007

I had my consult a month ago just need to turn in my 5 year history and one more month of diet. I'm just a little nervous about getting approved by the insurance co. but sounds like if you meet their criteria they will approve. I can't wait to have surgery and get started with the rest of my life. Thanks your reply!