BCBS of Texas coverage

[kristie_r32 0]

I have read on here that some have had good luck getting bcbs of texas to cover lap band surgery. I however would not be one of those lucky ones. Not sure if they have changed their policy or I just have the wrong policy. It is in no way shape or form covered. :biggrin:

[ParrotheadCathy 0]

There is the potential for every employer's policy to be different from the others. It happened to me....my BCBS of GA doesn't cover weight loss surgery or care at all; my best friend's BCBS of GA policy does. Sucks!

[TexasMama 2]

I am in the same boat--I just found out today that while morbid obesity isn't an exclusion itself (the company will pay to find that out, apparently, with super-helpful diagnostic testing! *big eye roll*)--any surgery is NOT covered. This really, really, really sucks. I could have had this done when we were in Houston with my husband's old employer, but with our new insurance (United Healthcare PPO), his company has opted NOT to cover that surgery. His company is one under the Bristol Bay Native Corporation of Alaska umbrella btw (though we're in San Antonio)...yeah, isn't obesity like a huge problem in Alaska? Get on the ball, BBNC... *sigh*

I was really hoping to get my surgery done in January. I am just devastated! :biggrin:

[kristie_r32 0]

I happen to have an abdominal hyernia... that they will pay to have removed. the same surgeon does both. then they only charge 1700.00 to do the lap band. insurance pays the anestesia , hospital and what not. i pay for the lap band, dietian. around 3000.00 all together. better than 15,000.00...

good luck

[Karen12345 61]

Hi Texas Mama! I am sorry that your BCBS didn't cover it. I have Anthem BCBS and so I went thru a great doctor that took my coverage. The cash price was $12,400 but because I used my insurance, it ended up being over $40,000 at Methodist. Apparently if I had walked in there and plunked down $12,400, the doctor and the hospital woulda/coulda done it for $12,400. His name is Ziad Amr and he was and is absolutely great! I'm also in Houston. Let me know if you need anything!

Karen

[rldm 0]

I have BCBS of Texas through MD Anderson Cancer Center and I have been told they will pay, IF I meet certain criteria. Is anyone here from the Houston area? I will be going for my 3rd appt this week. BCBS requres 6 appointments before they will consider the surgery.

[TexasMama 2]

Hi Texas Mama! I am sorry that your BCBS didn't cover it. I have Anthem BCBS and so I went thru a great doctor that took my coverage. The cash price was $12,400 but because I used my insurance, it ended up being over $40,000 at Methodist. Apparently if I had walked in there and plunked down $12,400, the doctor and the hospital woulda/coulda done it for $12,400. His name is Ziad Amr and he was and is absolutely great! I'm also in Houston. Let me know if you need anything!

Karen

Hi Karen! Actually, I'm with United Healthcare PPO, they're the ones that denied me. I was previously with BCBS TX.

We are now in San Antonio and I have found a doc that charges $12K. I am going to have to figure out if we can do it.

I have BCBS of Texas through MD Anderson Cancer Center and I have been told they will pay, IF I meet certain criteria. Is anyone here from the Houston area? I will be going for my 3rd appt this week. BCBS requres 6 appointments before they will consider the surgery.

Hi rldm. Before we moved to San Antonio last month, my husband worked for MD Anderson for 15 years. We had BCBS of TX through them. They WILL pay, but they do have restrictions. I believe one of them is that you must have a BMI of 40, plus you have 6 months before they'll do it. If you meet their requirements, you will be approved. I was SO close...then we had a job change. *sigh* Good luck to you...:thumbup:

[shannonlouisiana 0]

Hi I also have BCBS of TX and you might want to call and check they changed their 6 months to 3 months in September of this year I have the Band but am looking into having the Bypass and that is what they told me.