Texas Risk Pool Insurance - High Risk BCBS Stonewalling My WLS

Has anyone gotten their Texas BCBS Risk Pool Insurance to pay for obesity surgery?  I can only have the lap-band due to health issues, but my hubby needs a GB.  (Details below.)

I have insurance through a state directed program, in their "high risk pool", due to a very long list of pre-existing conditions which precludes me from otherwise procuring insurance like a normal person.  Fortunately, the great State of Texas, provides us with a risk pool through BlueCross BlueShield, but (there is always a but, isn't there?) they will NOT pay for obesity or obesity related surgery.   

They won't pay for it even if you have five co-morbities and your BMI is 50.  They don't care.  They apparently have not figured out the cost savings of doing the surgery either, but it isn't my job to run the insurance company.  It is my job to try to work toward some sort of acceptable relationship with them and to take care of myself.  All of my doctors have green-lighted me for a Lap-band and are kind of ticked now that my PPO won't pay, pay, pay.  Isn't this what I pay them $700+ a month for???  <-- that amt is just for me

I actually eb and flow between two and three co-morbitities depending upon my health.  My BMI has been as high as 66.  It is currently down to 54!  Yay!   FYI - My BMI has been as low as 20, but my goal is 24 and my doctors say that they would be happy to see it at 32.

My husband, who has the same insurance and same issues with different health considerations, has five or six co-morbidities (some people count depression and some don't) with Type II Diabetes being the most alarming.  He is a varitibal metabolic timebomb waiting to go off and luckily, as unfortuniate as his recent diagnosis is, it has gotten his attention and moved him to action.  His BMI is 34.4, so he could eat a couple of steaks and add the extra pound needed to push him to 34.5, thus rounding him to 35 and qualifying for the surgery.

I'm the BIG one.  When we went to the seminar to see Dr. Nickolson, we didn't know that my husband would be the one who needed the surgery more urgently than I do.  The good thing is that we form our own little support group, but the bad thing is that we are stuck in the same insurance boat which brings me to my original question:

Has anyone gotten their Texas BCBS Risk Pool Insurance to pay for surgery?  If so, when and how?  Who was your doctor?

Thank you in advance!!!
 

Your height might be wrong, and this will affect your BMI. I would suggest talking to other doctors.

James

Actually, I do have a unique set of cir****tances that play into all of this that jack with my BMI due to the fact that I have severe osteoporosis and I have broken a number of the vertebra in my back - virtually every one from my bra to my tailbone with the exception of four.  I started gaining weight from an unsuccessful pregnancy during bed rest and then immediately after that I had six back surgeries one after another to stabilize my spine so that I wouldn't be paralyzed or lose any further nerve sensation.  That is a big part of the reason (no pun intended) that I gained this weight to begin with.  I kept eating the same way that I used to even though I was confined to a wheelchair. 

When I was my normal, healthy, active, unfractured self, I was 5'3" and 135 pounds and I wore a size five.  I battled anorexia for years and the smallest that I ever got was 115 pounds and a size one (back then sizes were made differently: 0, 1, 2, 3/4, 5/6, etc.) with a BMI of 20.  Then when the fractures began my spine compressed.  I have concrete in there now and I have been given a lot of hormones to help regenerate my bones which helped me regain an inch of height (Praise God because that is all I needed to reach the middle shelf at our house), but at my shortest and heaviest, I was 4'11" and 333 pounds which gave me a BMI of 67.  Thankfully, my new height brought me back up to 5'0" and I have been able to lose 50+ pounds, so now I am at 276 and a BMI of 54!   

And, I might add, I haven't been confined to my wheelchair 100% of the time or stuck in the hospital for several months.  I started this weightloss journey in July and it isn't going to be easy, but this is totally off topic....  I do have my BMI calculated correctly, don't I?

This brings me to my original concern: Has anyone had any luck with The Risk Pool?

Would y'all please reassure me that I am correct about my BMI too?

Thanks!