Health Select PPO thru State of TX

[loube910 0]

Health Select Insurance

Hello,

I have question. I work for the State of TX and have Health Select PPO insurance through my job.

I am more than 100 lbs overweight, I have 2 drs my primary & my orthopedic who have written letters of medical necessity for the surgery. But the insurance reps I have talked to all say no way - never- they dont cover Weight Loss.

Is there anyone out there who has this insurance thru the State Of TX that has been approved? IF yes could you provide me all the details & info?

thanks,

MB

[KClark 0]

I know that you posted this a long time ago, but I was wondering how it worked out. I am also a State of Texas employee.

[TXbandit 4]

I was a TX state employee when I had my surgery in December 2008. I had to self-pay. I also used to work for the Dept of Insurance, and if your insurance doesn't cover weight loss treatments, they don't have to cover it even if it is medically necessary. I just considered it "my new car..." and made payments like car payments!

[KClark 0]

That's exactly what I thought. I am planning to self pay. Yes, this will be my "new car" too! Thanks for the info.

[tiffanyannette 0]

I work for the state of TX as well, however it is important to know that any type of WLS is excluded. Good news is that when the legislature met a few months ago, it was passed that ERS has a certain amount of time to add it to the plan. The last I read they had until the next open enrollment period. Of course they will probably have a trillion qualifications and requirements, so you'll more than likely have to wait it out. I know you have already prepared for self pay...just wanted to give you the updated info as I know it. Good luck!

[KClark 0]

I have spoken to someone at ERS and they said that the bill that recently passed only allowed ERS the ability to research the option of WLS and how cost effective it would be to add it to our health plan. They expect to have the results of the research by Sept. of this year, which means they would present it to legislature next time they meet (next year) and then they would decide. If they decide to pass it probably the earliest it would be offered is Sept. 2011. But with all of the recent budget cuts and the $148 million shortfall for State of Texas employees health insurance we are facing for FY 2011, I don't think it will get passed anytime soon, if at all. So, I'm going to bite the bullet and pay for it! I just don't think I can wait with all the uncertainty. Best of luck to you too!

[ItsMeCricket 0]

Board makes changes for PY2011 :: Employees Retirement System of Texas

Actually, I read this and believe this to mean they are covering bariatric (not sure which) surgery effective September with a $5000 deductible in addition to the normal charges, but you have to have 5 years of state employment history to qualify.

It is a very exciting development!! Now, if they will just show me which hoops we're going to have to dive through...