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All Insurance In Texas Is Excluding!!!



WHO IS THE BETTER LAP BAND DR IN DFW?  

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  1. 1. WHO IS THE BETTER LAP BAND DR IN DFW?

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I Have Been On The Phone Alllllll Day Calling Insurance Companies To Change From Bcbs! E V E R Y Single One Is Saying That They Are Excluding Any Coverage For Weight Loss Surgery Even If It Is Medically Necessary! Can Anyone Help Me!?!? I Think Im Ready To Go To Mexico! Im So Overwhelmed! I Was Ready Yesterday To Have This Surgery! It's Time! I Live In Texas, Does Anyone Know Who I Can Go To Cover?

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Are you talking about private ins or thru your employer? If its thru your employer its based on what type of policy that they purchased. I know for my work we have either Cigna or UHC and WLS is a covred benefit for this year and for next year as well.

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i am trying to get a small business insurance, through our company, but every time I say that they still say it's excluded. I just wish I had a "copy" to say, OKAY I WANT THIS POLICY. Am I crazy or what?

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You're not crazy, no. Try calling the state department of insurance to find out if there are any state regs governing benefits and coverages. A broker might help you navigate the territory. It may be that small businesses can only buy bare-bones types of policies with lots of blanket exclusions, but there may also be carriers offering more comprehensive policies to qualifying customers. We can't tell you for sure since it's all state by state. Good luck!!

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Thanks so much! As you can tell, I think I'm ADD! I can't stand the wait! Especially since I just found out about this Dr. Stephen in Mesquite Texas. $10,150 for everything! I think Im just going to try and figure out a way of getting a loan, so that I dont have to go through all the fighting for months and months only to be denied and waste the time. IO hate the out of pocket, but I am so ready to LIVE again I cant stand it!!! Congrats on your weight loss!!! You're amazing! I am 5'3" and 218 pounds! 20-22W! So frusteratinf tryin to just wipe my butt!!! GRRR! Anyway, thanks for your help...

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Guest pmcig

Thanks so much! As you can tell, I think I'm ADD! I can't stand the wait! Especially since I just found out about this Dr. Stephen in Mesquite Texas. $10,150 for everything! I think Im just going to try and figure out a way of getting a loan, so that I dont have to go through all the fighting for months and months only to be denied and waste the time. IO hate the out of pocket, but I am so ready to LIVE again I cant stand it!!! Congrats on your weight loss!!! You're amazing! I am 5'3" and 218 pounds! 20-22W! So frusteratinf tryin to just wipe my butt!!! GRRR! Anyway, thanks for your help...

Do You have any additional information on Dr. Stephen?

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Guest shycindy

My husband just started a new job and before he was even hired, he got insurance info, so I called them and they said lapband was covered.

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Guest missb

I agree with an earlier poster. It is all about what type of exclusions your employer elected for your insurance coverage. I work for a small organization and serve as plan admin for our insurance coverage...there is a box that you can mark to EXCLUDE/INCLUDE WLS or things like hearing aids, etc. my boss decided to INCLUDE THEM and that costs more for this benefit. So I'm sure most employers EXCLUDED it from their insurance plans, so it will not be covered. I'm just checking into this because i was hoping to have changed jobs by now, but I haven't, and I'd like to go ahead and see if I can get covered. I was told that a dr. in houston works really hard to get it covered by your insurance company and that you don't have to do much work because they know the "right" words, etc to get it approved. BCBSTX does cover lap band surgery..i'm not sure about gastric bypass

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Guest kbuttons37

missb, do you know which doctor in Houston works to get it covered by insurance?

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I know you're upset.

But you're wrong.

ALL insurance companies in Texas are NOT excluding weight loss. No state agency rules over all private insurance company and no such law has been (nor could be passed).

So although you didn't mean your thread title to be misleading, it is.

And, No matter what you think, calling insurance companies to see if they provide Weight Loss Surgery as a benefit is NOT the way to go.

Of course, they are going to tell you "NO" - if your employer gives you that many options for insurance and you called each one and each one told you know (insurance companies routinely instruct their employees to say "NO" to blanket requests like that anyway - they don't want to 'cover' some employee who just wants to have the insurance long enough to get their $30K procedure covered.:eek: )

Each and every insurance company makes its own coverage rules. And each and every employer makes the decision whether to include or exclude procedures like Weight Loss Surgery. YES, the insurance companies are putting the heat onto larger employers to exclude such types of expensive coverage for WLS (in other words, insurance companies charge employers MUCH more for policies that don't exclude WLS than for those that exclude WLS, which the insurance companies prefer, of course - but it's each employers decision.)

So take a deep breath and examine your options carefully. With some diligent work and research and TONS of perserverance even an exclusion can be beat. If your employer's HR department is willing to work with you (some HR reps are, although they're generally very busy) then you have a better chance than if you fight it alone.

But either way, you should also concentrate on your employers' policy, rather than expending energy contacting random insurance policies.

Thousands of people have this surgery each year (Covered by their insurance, and thousands are in Texas) and you can be among them.

Good Luck on your journey.

Sho

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missb, do you know which doctor in Houston works to get it covered by insurance?
hadar spivak has a great staff who will help you as much as they can. i have great west ppo and am in the process of getting my ducks in a row...so i know how important it is to have someone in your surgeons office on your side. good luck

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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      1. LeighaTR

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
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