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Hi all. I am posting as a follow up to many other posts regarding BCBS of TX via TRS active care 2 (for teachers in Texas). I have just been informed by my surgeon's office and by BCBS TX that the TRS plan does not cover VSG, but does cover RNY and Lap Band. So, if you have this plan, you will have to choose between the RNY and Lap Band. As of this plan year, VSG is NOT covered. I am disappointed because I have been in contact with BCBS TX and my surgeon's insurance people constantly since January and I am JUST NOW finding out that VSG is not on my plan, despite having said VSG in every single piece of correspondence since January. Oh, well. RNY here I come! Probably will be better for me in the long run anyway!

Hi all. I have not been officially approved yet because I am still in the "meeting the requirements" process. I have received two letters from BCBS TX stating that all WLS are covered including VSG. My surgeon's office has also contacted BCBS TX on my behalf and have received the same information. That's why I am continuing on with the process for meeting the requirements. My surgeon's office has told me that in 2010 they have already had a few VSGs approved by BCBS TX. It may be that the BCBS TX coverage depends on your employer's exact plan. My employer is a school district with TRS Active Care . BCBS TX did tell me that not all employers have opted for the WLS coverage on their plans. According to my BCBS TX rep, it is inaccurate to say "this ins. company does or does not cover WLS". The coverage depends on what the employer has elected in the plans they offer to their employees. Hope this helps. I will post again when I find out about my approval, or denial, whichever the case may be. I have 11 days till I will have met EVERY single requirement BCBS TX listed on their LENGTHY requirements list!

Hi. I have Blue Cross Blue Shield of Texas and my plan does cover these surgeries. I am still in the approval process, but I have been in contact with my insurance company and have recieved documentation on thier requirements. It IS covered for sure. No one has mentioned to me that there is an "automatic across the board denial" mandated by Texas. I look forward to seeing more responses to this post!

Do any of you know what Dr. Nick Nicholson's (Plano, TX) pre-Op diet regimen is? I am looking for the number of days per stage and types of foods you can eat each day or stage. Thanks!

jeaniwantsasleeve, I am just trying to have ONE place where everyone can tell their story about getting denied. I read the boards everyday and there seem to be a lot of people who were denied and are appealing or have appealed sucessfully. Like you, I am pretty sure I'm going to be denied on the first try...so I want to see some appeal success stories!! I am so worried because I will be changing jobs soon and my new employer does not have insurance that covers VSG. It is now or never!!! Thanks to everyone who has replied to my post. Sorry to see there aren't more though! Makes me very nervous....

Lovesthebeach, I too have PCOS and insulin resistance. I also have hypothyroidism but no comorbidities. I noticed there is a place on this site for other health issues, but no one ever posts there! Unfortunately, I have not had the VSG yet and am still in the insurance approval stage. I have talked to my endocrinologist and my potential VSG surgeon about having VSG and they both agree that it is a good idea and seem confident that I can still lose weight with these conditions, though possibly not as much as without hypothyroidism. Hopefully, others with PCOS will post about their experiences. For those who don't know....PCOS stands for Polycystic Ovarian Syndrome. It is a hormonal imbalance which can lead to weight gain, diabetes, heart disease, hypothyrodism, infertility, etc. According to my endocrinologist, it does not necessarily mean that you have actual cysts on your ovaries, but is more about the group of symptoms and blood test results. Good luck to you! I've decided to have the VSG and am anxious for my insurance approval!

Hi all. Would those of you who have been denied for VSG by your insurance company please respond to the following: Reason your comany gave for denying your VSG Insurance Company's name How long was it between the submission of your paperwork for approval and the denial by your insurance company? Action you took for appeal Was your appeal successful or not? If so, how long did the appeal process take? Thanks!

Just a note about FMLA... there are certain requirements that have to be met before you are eligible for FMLA. You said you were new to the field of nursing. In order to be technically eligible for FMLA, you must have worked for your employer for a certain number of hours (1250) and months (12). Be sure to check into the actual law on the department of labor website.

Just for clarification, I have BCBS of Texas. It is not federal or for any other state. My benefit has been verified. That means that, yes, BCBS of TX DOES cover the VSG and HAS verified that with my doctor's office. They have listed out the requirements for approval. Yathink, I do not understand why BCBS would say "it is not covered" if you have the benefit on your plan. Perhaps they meant "you are not approved" for whatever reason...which they should have stated in their denial letter.

Nic, Honestly, no. I did not double check by calling BCBS myself. I was just going with what Dr. Nick's office said since they work specifically with the insurance companies all day long...and I'm sure they would want their patients to jump through any unnecessary hoops. Perhaps I will call.... Have you heard something different from them? Thanks!

Hi all. I got a a letter from Dr. Nick's office about the verification of my BCBS TX benefits and their requirements for approval. The following is the ACTUAL text from the letter about the verification of my benefit and what BCBS requires... hope this helps someone. This is not an approval letter from your insurance company. This is a letter to notify you of criteria your insurance company requires of you. Please read through this letter's entirety. Thank you for your interest in the Weight Loss Surgery Center at Baylor Regional Medical Center at Plano. This letter is to inform you that your insurance carrier, Blue Cross Blue Shield of Texas, has approval criteria for weight loss surgery. The Medical Review department has made it very dear that all requests for weight loss surgery must adhere to their requirements precisely or they will not consider the request. As a result, you will need to obtain the following documentation: 1. Medical record documentation of active participation of a doctor supervised, non-surgical program for at least 3 months. occurring within the past 24 months and preferably unaffiliated with the bariatric surgery program. This means 3 monthly visits with your PCP or a registered dietitian and will include the following: • Nutritional therapy. which may include medical nutrition therapy such as a very low calorie diet such as Medifast. or a recognized commercial diet-based weight loss program such as Weight Watchers or Jenny Craig. • Behavior modification or behavioral health interventions. • Counseling and instruction on exercise and increased physical activity. • Pharmacologic therapy (as appropriate), • Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health. 2. Psychological evaluation and clearance by a licensed mental health professional within the 12 months preceding the request for surgery. 3. Per recent ASA (American Society of Anesthesiologists) recommendations, a pre-operative sleep study is required to assess for possible obstructive sleep apnea. This diagnosis is very important in assisting our anesthesia team in providing optimal care. Furthermore, a diagnosis of obstructive sleep apnea is frequently a major determinant as to whether or not one qualifies for bariatric surgery. This is one of the most common disease processes associated with morbid obesity. You will be required to have this diagnostic test prior to surgery. This requirement also remains in effect even in patients already with a diagnosis of sleep apnea under the following circumstances: Greater than one year from a previous sleep study or a weight loss/gain greater than 15 lbs since the time of your last sleep study. We understand that this situation seems frustrating and time consuming. but please know that our office is here to help you during this process. Once you have obtained the necessary records, please mail or fax them to our office to my attention. A Letter of Medical Necessity along with your documentation will then be sent to Blue Cross Blue Shield of Texas. **You may want to take a copy of this letter to your physician(s) and see what they can assist you with.** EDIT: Spoke to Dr. Nick's office today, 2/15/10...the three months of supervised weight loss treatment required by BCBS TX must be three CONSECUTIVE months!

Hi. I have been watching this post since Monday and see that there are still no responses. I also have BCBS TX and am wondering about approval for VSG. I am just beginning this process and hope to have Dr. Nick in Plano do my surgery. When I talked to the ladies in his office on 2/1/10, they said that they have not had any approvals from BCBS TX for VSG this year. They acutally had two denials in January and are appealing now. They did say they had several VSGs approved by them last year...so.....who knows?? I know this is not what anyone wants to hear (including me!)...but I thought I would share what info I have. The nice ladies at Dr. Nick's did say that they are sure they can make "something" happen! I've got my fingers crossed! I hope others will post any recent info they have on BCBS and VSG approval.