BCBS of Texas- WLS requirements

Hi all, if any one has used BCBS of Texas and gotten approval for RNY, what were the requirements for WLS. I have been trying to look on their website and have not been able to find anything. Thanks Casey

If you can't find it then call your insurance company and tell them you want the guide lines in writing on what you must do in order to get approved for Bariatric Surgery. Donna

Casey, I have BCBS of Texas PPO & my husband was approved for RNY, but I just got denied for LapBand! I don't have the explanation yet, so I don't know the exact reasons for the denial. It took lots of patience with his though! They wanted Psych Eval, Nutritionist consult, 5 years of records, letter from primary care doc stating medical necessity, 12 months continuous weight loss attempts documented by physician. Then at the end, they came back & said they didn't have his height, weight or bmi. That was the first thing the surgeon sent!!! I will appeal whatever the reason! Anyone have a got 1st appeal letter example? Thanks, Hugz, Gina L

Look at the page for Sharon Neva. She includes lots of useful info and I think there is a sample appeal letter. Best of luck.

For everyone with BCBS, be sure and have the surgeon put a surgery date on the approval request even if you don't have a scheduled date. I found out that my name was not even in BCBS computers even though they have had the paperwork over 2 weeks. I asked her what took them so long on the approvals. To distract me the lady asked what was my surgery date, and in the process, I found out that if your approval does not have a surgery date listed then they keep dumping it on the bottom of the pile under the ones that do have surgery dates listed. They do not do them by the order that they come in --- but by surgery dates, so as long as anyone kept sending in approvals, I would stay on the bottom.