BCBS TX - Approved

[Carrie D. 0]

sandahlia...

Congrats! I'm a bit confused...how did you complete the 6 month supervised diet in 3 months? Were you already seeing your PCP for the weight loss?

I have TRS BCBS too and am trying to get approval from the insurance comany.

[candy8360 0]

I also have BCBS, but in Georgia. My sister also has BCBS, but was denied. I was approved after about a week also. I was told it all depends on the plan your employer has, not neccessarily that it is BCBS. It did take about three and a half months to finish all the requirements, but then it was sent up and the approval was given quickly. My surgery is Tuesday morning (2th). I'm very excited!

[sandahlia 0]

I'm sorry to hear that but maybe you should reconsider submitting your paperwork to BCBS just in case they do approve you. The following link will direct you to BCBS TX medical policy on weight loss surgery Blue Cross and Blue Shield of Texas Obesity Management Web Site for Members

My surgeon's insurance coordinator followed this to a "T" and that made the difference for me. I hope things work out for you.

[sandahlia 0]

I was already on a supervised diet and only had a couple of months to go. I definately had to do the 6 month diet like most people.

[sandahlia 0]

Yeah, we have BCBS TRS Activecare which is Teacher Retiement System here in Texas. You're right every employer has a different contract, which is tough. I'm on my husband's insurance because my employer will in no way cover wls. Congratulations on your upcoming surgery. Let me know how you are doing.

[EricCharbonneau 0]

I had good luck with BCBS TX. They approved and paid for my lapband procedure. Process took 4 months from initial appointment to surgery. I was a diabetic (oral medications, poor blood sugar control) and had a comorbidity of sleep apnea. So I had to do a sleep study, psych study, etc. My initial BMI was over 44.

I feel very fortunate that BCBS TX covered my procedure. I'm doing well and am off all diabetes medications and my blood sugar tests in the normal range. I am confident that BCBS TX made the correct decision. My diabetes medications alone would have set them back more than the surgery over the years.

Good luck with your insurance submissions. Get the procedure done even if you have to self pay.

[Just_A_Girl 0]

If I were you, I wouldn't take no for an answer. I am 5'1 and about 225-230. I have HBP. I have BCBS TRS with a Texas school district. There are several people who work for the district and have been approved. I would at least try it ... and if it doesn't then you can pay. Definately give them the opportunity to pay it first!! I will be submitting my paperwork to insurance in a couple of days and I will let you know how mine goes. If I get denied I will fight it. If I lose I will not be able to pay for the surgery b/c I am a single mom with 4 young kids, I work full time, and go to school full time too! ... oh yeah ... I live off of an aide's salary!!!! lol

[Carrie D. 0]

Okay...I'm getting hugely frustrated here. Yesterday, I spoke with a customer service rep at BCBS TX. I asked about the 6 month diet thing. The customer service rep said that she didn't think that the diet had to be consecutive 6 months...just a total of 6 months within 24 months of the surgery date. The Blue Access website isn't much help either. I just says that there needs to be 6 months of supervised diet...but doesn't specify whether or not it has to be consecutive. WHAT THE HELL? WHY CAN'T THE INSURANCE JUST SPELL IT OUT FOR ME AND OTHERS?!?! :angry

Furthermore, I got my welcome packet from Tyler Bariatrics and it states that BCBS wants 6 months continuous dieting.

:faint:Why, oh why am I getting such conflicting and confusing information?

Anyone able to offer some words of wisdom?