BCBS Tx TRS time to approval?

Just wondering what anyone has had to wait for approval through TRS Activecare 3? I have seen the Dr., going to the Psychologist this week and I am waiting for the insurance coordinator to review my medical records to be sent off...anyone have any support for me?

It will totally depend on your medical history, issues, type of surgery and then if you have met all the other criteria. It could be a few days up to a few months.

I hope they approve you soon!

Karla

It took me about 2 weeks to get approved with TRS. bmi of 43. My surgery scheduled for July 25.

Congrats on getting approved and on your surgery! Did you have to have 6 consecutive months or just 6 months in a 24 month period? That is the big question at my dr. office.  Any help you can give me will be greatly appreciated!

 Thanks... I started my diet monitoring in January.  When I started, the monitoring period, it was only 3 months, but was changing to 6 months consecutive in March, so Baylor had me do 6 months just to be sure.  I had 3 months of monitoring last year before we switched insurances on January 1 in our district and had to start over.  With activecare 3, the dr bill is $450.  I'm guessing ill receive a seperate bill from the hospital once it's over, as I've gone and done the pre-admit stuff and haven't heard anything yet about the bill.

I have Activecare 3, our district started on July 1st.  I have called 3 times and they had me print out the information from BCBS TX site, it states that...

2.  Evidence that comprehensive non-surgical treatment of morbid obesity has been attempted prior to surgical treatment of morbid obesity: 

• Documentation of active participation in a comprehensive, non-surgical program of weight reduction for at least six (6) months, occurring within the twenty-four (24) months prior to the proposed surgery.  
• NOTE: The initial BMI at the beginning of a weight reduction program will be used to meet the BMI criteria for the definition of morbid obesity used in this policy.

So needless to say, I need help to understand....there is not one person at TRS that has told me it is to be consecutive...HELP!!!

Are you still on plan year 2010-2011, or is it 2011-2012?  I know that some specific provisions were put in for bariatric for 2011-2012, such as 5000 copay. I'm not sure if requirements changed with that.  It's one of the reasons I was pushing to get it done before Sept 1 before are plan year rolls over, plus I downgraded to activecare 2 for next year.

 Oh, and the diet monitoring had to be 6 consecutive within the past 2 years.  I had to start over because I skipped a couple months when I  found out we were changing insurances.

Yes, we are on the 2010-2011 plan year, did they tell you specifically 6 consecutive months?, I am hearing from you consecutive but the TRS lady I spoke with on Friday morning told me not consecutive...Oh, lordy, I am so frustrated! If it is 6 months then I am going tomorrow to the Dr. to start the diet thing again....

I would go with what the insurance coordinator at the dr you seeing has told you.  They should have verified everything for you and should be able to readily contact people at bcbs and get the correct info.  I had 3 months of monitoring last year, and Baylor had me do another 6 consecutive... they may have just been cautious on getting the approval.  As soon as I gave the insurance coordinator the new insurance information, she knew what the requirements for me would be right away.  I am going through the official bariatric program at Baylor in Dallas, so they might have their own requirements for the program in addition to insurance.

If you want to double check with bcbs, call and write down every name you talk to and ask for an agent id if they have one.