blue cross blue shield of texas

[muchlady 0]

have anyone been approved by blue cross blue shield of texas?

[ShawnaLynn 0]

If you find out about that could you let me know! Id love to know as well!

ShawnaMcNair@yahoo.com

[pugutopia 0]

Yes I had BCBS PPO of Texas pay for my lapband surgery in May 2008. I have lost 80 pounds in 5 months. BCBS made me follow a 6 month dietician controlled diet prior to the surgery, needed a 5 year weight history and a BMI of 35 with two major health problems or a BMI of 40.

I had diabetes, high blood pressure & high cholesterol.

My BMI was only 35, but they approved it! Since the surgery my diabetes has been reversed, my cholesterol is normal and my high blood pressure has gone away!:redface::smile2:

[ladybugchaser 0]

I have two coworkers who were approved with them.

They wanted me to be 100 pounds heavier with more comorbidities...lol...my comorbidities are covered in Kansas...just not here, go figure!

So we happily sucked it up and went self pay. Best choice EVER.

Bless you all who are fighting with insurance and paperwork and documenting crap. I had to do a few pre op tests...but I basically paid and was 'on the table' a few weeks later.

* * * Advice from bariatric coordinator at my doc's office... DOCUMENT, DOCUMENT, DOCUMENT. She said the main reason people are turned down by bcbstx is that they don't have enough documented proof of everything. Get letters from everyone stating your case.

Edited September 26, 2008 by ladybugchaser

[pugutopia 0]

Dear ladybugchaser, My daughter has visited my doctor and he agreed that because of genetic makeup (she has a 38 BMI) she is a candidate for the lap band surgery but because she only has high Cholesterol, Insurance will not pay. If you don't mind me asking about what did private pay cost? I don't need exact just approx, I hear PP is much less. Also she lives in Waco not to far from Collage Station. Is there a doctor or clinic you would recommend, She has been seeing mine but i am in San Antonio. Thanks Pugutopia :thumbup:

Start/Current/Goal

289/202/167

Edited September 26, 2008 by pugutopia

[ladybugchaser 0]

Hi Pug!!

So lovely to hear from you!

I would totally recommend my doctor (Dr. John Mason- Brazos Bariatric :: Dr. John Mason). I was considering him because he was the only area doc that was recommended on this site by people in my area, have a coworker who was banded by Mason and LOVED him, Mason's staff LOVES him, and when I mentioned to my mother I was 'considering but not yet sold on him' she said...he did my second mastectomy surgery....do you want to see his work? (I didn't recall HE was HER doc!!!) Perfection and flawlessness compared to her first mastectomy. That was the exact moment I knew he would be banding me.

Here is what I paid...(I did compare to Houston docs/prices for fun and feel great about staying in CS). Surgeon - $2500, OR Assistant - $500, Anesthesiologist - $900, Hospital - $7300, Half Day Education class - $250...I think that's all. Wait - Two pre op appts with Dr. Mason - $150. They don't require the heart test if you are under 50, I did the mental eval by the people they recommend and had a GREAT experience!! That was covered by insurance for me, I already had recently had blood tests done by my PCP, so that was covered by insurance, I did have to get a chest xray but had my PCP request so insurance would cover.

Let me know if you have any other questions! I would love to help you and your daughter!!

LBC

[Westtexasdustdevil 0]

I just dont get it. I have BC/BS and called them today and they told me that NO WAY, FORM or FASHION would they approve this here in Texas. Called the main Office.

Then I called First Care (work offers both) and was told the same thing.

Whats the trick?

Rick,

Lubbock, Texas:sad:

[ladybugchaser 0]

Rick...

Have you been to an educational session with any docs in your area yet? If not, do so....and talk to their bariatric coordinator. They are your GOLD MINE. Talk to them about your situation....they work with ALL the insurance companies and can give you a pretty good idea about the outcome with your situation. They know who is difficult and who demands what....ie. They can assist you if you need it and know the tricks - for insurance. Self pay on the other hand is straight forward.

Good luck!!!!

Edited September 30, 2008 by ladybugchaser

[pugutopia 0]

Rick, ladybugchaser is right. Go to one of the seminars. Most will ask for your insurance information a few day before upfront. When you go to the seminar they will tell you under what conditions your insurance company will pay, let them work it for you! They know more about this stuff then we do. I was told by many of BCBS group holders that they called and they said they would not pay. Yet low and behold when I went to the seminar, The bariatric coordinator said that they had approved under the following conditions 6 month dietitian controlled diet prior to the surgery, needed a 5 year weight history and a BMI of 35 with two major health problems or a BMI of 40. depending on what policy you have the conditions may vary. Don't give up.. I hope this helps Robert

Start/Current/Goal

289/201/167

Edited October 1, 2008 by pugutopia

[ChubbyMama 0]

The bariatric coordinator said that they had approved under the following conditions 6 month dietitian controlled diet prior to the surgery, needed a 5 year weight history and a BMI of 35 with two major health problems or a BMI of 40. depending on what policy you have the conditions may vary.

What constitutes 2 major health problems? Can depression qualify as one of those?

I am about 80 pounds overweight, have a BMI around 35. My health problems are depression and minor sleep apnea (which I was told would improve if I lost weight). No diabetes, no high cholesterol or anything. I've spent a few thousand on a personal trainer and weight watchers without lasting success. I just can't control my appetite and am at my wits end here. I don't understand why they want you to be so sick before paying for the surgery. You would think the insurance companies would benefit more from a preventative medicine standpoint than waiting until patients get horribly sick from their obesity!

Anyhow, is there a list of qualifying health problems somewhere? I don't have $13,000 to pay for surgery out of pocket, so that's not really an option for me. I have Blue Cross Blue Sheild EPO (similar to HMO but with PPO perks).