has anyone had any luck with BCBS of Tx. yet if so how did you do it..

has anyone had any luck with BCBS of Tx. yet if so how did you do it..

I did get approval from BCBS IL after an appeal. Since the code 43775 is still "investigational" I would guess everyone would get rejected once "43775" is read. For me, the appeal was easy - I just stated the facts and within 2 weeks was approved (surgery scheduled for 7/14)

Lou

My doctor told me that BCBS-TX said it was "billable" which means it should be covered. I have to go through three dietician appointments, have a psychological workup, and a ton of blood work! I will let you know if I find out more. I was told I would only have to pay my out of pocket maximum and even then that would be billed to me and I can make payments! Good luck!

I ask for "43775" and my approval letter has "43842"

I had BCBS HMO last year at my employer here in Dallas and all WLS was specifically excluded because my employer did not pick up that optional addon. During last fall I had the option to switch to Aetna PPO with did offer a benefit and began covering VSG in April so timing was perfect. Good luck!

Not sure if this is right but might want to check into it to be dafe

I googled the code 43842 and it says its vertical banding.

Vertical banded Gastroplasty (CPT 43842) and other forms of Gastroplasty (43843) - procedures designed to restrict food intake by limiting gastric volume. A 15-ml gastric reservoir is created by one of several stapling techniques. The small gastric reservoir empties through a narrow channel on the lesser curvature of the stomach to the residual stomach. The channel is reinforced with a prosthetic material to ensure a channel circumference of 4.5 to 5 cm. This operation is attractive because it preserves gastroduodenal continuity and avoids the potential for micronutrient deficiencie

I have BCBS of Texas (PPO) Federal Program..and my doctor's assistant helped us to completed all paperwork which consisted of 5yrs of medical records.

VSG: March 10, 2010

Dr. Jason Balette

Houston, TX

katethegreat.

did they give you a code for the billable and do you know what your max pay is.

just trying to get some info to go back to my Dr with.