All Insurance In Texas Is Excluding!!!

godley_gal · November 3, 2005

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?

piperbaby · November 3, 2005

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.

godley_gal · November 3, 2005

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?

Alexandra · November 3, 2005

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!!

godley_gal · November 3, 2005

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...

November 8, 2005

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?

November 11, 2005

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.

November 22, 2005

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

January 2, 2006

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

NewSho · January 19, 2006

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

kellcap · January 30, 2006

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