BCBS of Texas approved

[Carrie D. 0]

Wooohoooo! I'm approved for surgery!

I have BCBS of Texas through the school district (TRS Active Care). My paperwork was submitted on Tuesday, looked at on Wednesday. The insurance company requested better copies, the surgeon's office overnighted the paperwork. Paperwork was received by BCBS on Friday morning, forwarded to the medical review board after I called for an update. I called after work today and got the news that they had just sent out a letter of approval! So, 6 days from submission to approval.

Thank you, BCBS!

[TX Diva 1]

I have the same insurance and I heard a week later also! My friend who is the secretary at the school I work at also heard within days. She was recently banded, so she is my resident expert!

Good Luck on your surgery!

[ksandez 0]

are you saying that BCBS of TX does cover the Lap-Band????

[Carrie D. 0]

BCBS of Texas (TRS Active Care) is what I have. My insurance does cover it. There are all different kinds of BCBS of Texas and it depends on what options your employers choose...that's my understanding anyway. If you have BCBS, give them a call and ask for a copy of their policy.

[Carrie D. 0]

Woohoo! I hope to be a Jazzy June too. I'll know soon :cursing: When's your surgery date?

[ksandez 0]

I have the BCBS of Taxes PPO (Blue Choice)...How can i find out if Lap-Band its covered? I called BCBS and they release any informaton until June 1st...

[Carrie D. 0]

Here's the policy that I looked at. I don't think it's specific to TRS, but I'm not sure to be honest. Hope this helps :cursing:

Blue Cross and Blue Shield of Texas Obesity Management Web Site for Members

[ksandez 0]

what if i don't have:

Medical record documentation of active participation in a clinically-supervised, non-surgical program of weight reduction for at least 6 months, occurring within the twenty-four (24) months prior to the proposed surgery and preferably unaffiliated with the bariatric surgery program.

did you have all the information required for the Lap-Band?

My docotor told me that i was a good candidate for the surgery!!

and that she's willing to do the letter.

What did you provide to you insurance?

[Carrie D. 0]

If you don't have it, start going to the dr. or weight watchers as soon as possible. You can't get around the 6 month diet...I know because I tried every way possible :cursing:

Do call and double check with BCBS OR with your human resources person. They are the ones that will have the specifics to your policy.

[Carrie D. 0]

Also, do NOT miss any weigh ins or appts. Have your weight documented every month. I went to the doctor every 28-30 days. She documented my weight and that we talked about my diet each time. She also documented what changes in lifestyle I was making...i.e. walking, eating less, Portion Control, counting points, etc.

[Carrie D. 0]

I had to do the six months of supervised diet, a psych consult, & a nutrition consult.

[felkatz 3]

hi. I have bcbs of tx trs ppo. Beem 6 months for weigh ins but no actual diet. She just told me about diabetic diet took down what I've been doing. We r missing one year of my 6 yrs of obesity. Bmi is 43 no co-morbidities. Getting frustrated with all fees I have to pay barrium swallow 347 plus hospital fees. I decided to pay for my own. Tired of weighting. I don't think I'll get approved due to lack of documents and no co morbilities.

[10bluetoes 0]

How exciting for both of you!! I can't believe how fast your approvals went through. I have BCBS of New Jersey and they have had my paperwork since June 16th and I am STILL waiting!! Guess that is the difference between Texas and New Jersey, eah? :thumbup::tongue:

[ParrotheadCathy 0]

Felkatz....most insurance says a BMI of 40 with no comorbidities is the threshhold for approval. You're there. If you proceed with self-pay, ask your PCP to make referrals for your testing and because of your weight, your insurance should pay for that. But I would hold out for insurance approval.

A really good thing to do would be to call your insurance customer service number yourself and ask about requirements to be approved. And it may be that since you have a proven history of obesity both before and after the missing year, you'll be fine. It's always best to talk to your insurance company yourself. That way you have the answers from the horse's mouth.

[wacogurl 0]

Here's the policy that I looked at. I don't think it's specific to TRS, but I'm not sure to be honest. Hope this helps :thumbup:

Blue Cross and Blue Shield of Texas Obesity Management Web Site for Members

Thank you for sharing that website! I have BCBS Lumenous but I am in TX so I figure its probably pretty much the same. It was very helpful!:thumbup: