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BlueCross BlueShield of Texas

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Started by Oregon Rose, Jul 22, 2009 5:38 PM
2 replies to this topic
2 replies to this topic

    Oregon Rose

    Senior Member

  • Posts: 80
  • Joined: Jul 2009
  • Location: OR
  • Surgery: Gastric Sleeve
Posted July 22, 2009 - 5:38 PM

#1
:tongue2: Has anyone out there gotten BlueCross Blue Shield of Texas to pay for a Sleeve Gastrectomy?

Thanks!


    TennJenn

    Guru in Training

  • Posts: 242
  • Joined: Jun 2009
  • Location: AL
  • Surgery: Gastric Sleeve
Posted July 22, 2009 - 7:11 PM

#2
I have BCBS of TN & I know they do not exclude the VSG as many other insurance companies do. I didn't qualify, but...

Have you called your insurance company? Each policy is different so even if one person with BCBS of TX got it covered, it doesn't mean that your particular policy covers it.


    Oregon Rose

    Senior Member

  • Posts: 80
  • Joined: Jul 2009
  • Location: OR
  • Surgery: Gastric Sleeve
Posted July 23, 2009 - 11:52 AM

#3
I have a written copy of the policy statement on bariatric surgery. If you qualify, they will pay for Roux-en-Y Gastric Bypass, Lap Band, and Vertical Gastroplasty (an outdated technique.) They consider sleeve gastrectomy to be "experimental." During the time that I have been satisfying their "6 months of medically supervised weight loss" requirement, I have been researching all of these various surgeries. So now that I have completed that all of the requirements and have qualified for bariatric surgery, I find that they won't cover the proceedure I want.

I have read a ton of articles in the medical journals (primarily Obesity Surgery and Surgical Endoscopy.) It is clear to me that sleeve gastrectomy has weight loss comparable to Roux-en-Y Gastric Bypass without the surgery risks and without the long term gastrointestinal problems such as dumping, diarrhea, malabsorption, etc.

The problem is that there aren't any studies reporting results over 4 years old in the literature. The reason my insurance company won't cover sleeve gastrectomy is that it is "considered experimental." :sneaky2: I was wondering if anyone with BCBS of Texas has been able to get around this problem.

Best wishes


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