Blue Cross Blue Shield of TX TRS Activecare

Mert · June 29, 2006

I am glad to be here! I just found this website and think it is grand.

I am currently seeking approval for surgery from the insurance in the title. Has anyone had experience with them? :help: the surgeon sent in about half of what is asked for in the policy book, but now insurance is asking for additional documentation. the surgeon's office is not calling my insurance. I am. And now I'm doing the legwork asking for more documentation from endocrinologist and internal specialist. Is this normal procedure?? Maybe the surgeon's office has some slackers working there?? Does it help to inundate with documentation? Should I send in articles from medical journals as well? I finally found a nice lady to talk to at BCBS!! She told me what more I needed and sounded encouraging... I hope she was sincere:nervous I am so nervous ... I attended my first seminar on May 30th, so I really just got started, no?:guess

sallyjo · June 29, 2006

Mert, Welcome to lapband forum from another Houstonian. I can't ans. your insurane questions but this board has a wealth of info. My doctor took care of all my insurance needs. I never talked to them. Went to seminar in earlry April and had surgery on the 25th.All I can tell you is to keep after them because it sure is worth it. Not a miracle worker but it sure does help. Keep us posted.:grouphug:

Mert · June 29, 2006

thanks for your reply Sallyjo,

oh I plan to keep after them!! And congratulations on your new band. I have been wanting WLS for quite a while but all my insurance would pay for was RNY and that was toooo scarey for me. I am excited about getting the band, even if I have to self pay. I hear there are some great docs in Monterrey. Now insurance policy says it will pay if there is medical need and at BMI 49, I'd say there is! I can't wait to be the beautiful chic I was 100+ lbs. ago. Just gotta get over this darn insurance hurdle...I'm considering using Dr. Spiegel also.

freebekie · July 2, 2006

Mert, welcome to LBT, keep talking to them and get all the information they want, sometimes you are required to do a whole physical exam, dont give up, work with your primary PC

Mert · July 2, 2006

Freebekie and Sallyjo,

I appreciate the kind words. This waiting game is no bueno! I already sent in a complete blood chemistry,that showed high cholesterol despite taking 20mg of lipitor/day, borderline glucose, depite taking 2000mg glucophage/day, a 24 hour urine test that showed slightly elevated microalbumin, a hormone assay showing testosterone elevated (polycystic ovarian syndrome) and on and on. I plan to send in more stuff from the internal specialist. And PCP doctor's notes showing discussion of diet, date/weight over a long period of time. Then I will start calling them. Gee, I'm convinced that I need the band, surely those insurance guys will be!:paranoid surely?

GayleTX · July 2, 2006

I have BCBS TX PPO.......each group that has a policy, tho, has its own agreeemnt with the company so it's not the same for everybody.

My clinic did all the testing and submissions for me and then assigned me to a surgeon. BCBS balked only at the part about 12 mo. supervised diet ...... the PCP's I'd seen had not made good notes. Judging from the posts of others they seldom back down on this so you might want to go ahead and start on it if you don't have it. Other than that, they required psych eval, sleep study, blood work, caridology exam. I think that's all. It may vary depending on your health factors. Don't bother sending them research.....they know.

BCBS told me in advance exactly how much my part would be to pay and that's exactly how it went. Since surgery, I have had to pay only co-pay for my fills but every surgeon/clinic seems to bill that differently. You might ask your doctor's office now so you won't be caught by surprise.

(If I had gone to the surgeon's office, it would have been $150 per fill, no insurance accepted. Instead I use the clinic that did my pre-op and it's co-pay only).

There are many people on this board who have used Dr. Spiegel so you should be able to get some specific answers. I also see his name a lot at ObesityHelp.com.

Best wishes!!