Question:
Does anyone have Blue Cross Blue Shield of Texas?

Do they really require 5 years of medical history of obesity treatment before they will cover Lap-Band? That is so rediculous! They know we give up because its so hard to keep seeing a doctor who medicates with no real results in keeping weight off, do I have top wait 5 years???Help anyone!!!    — [Deactivated Member] (posted on June 5, 2007)

June 5, 2007
My PCP went back through my medical records and pulled all of my weights from my doctor visits, documented our discussion about my increasing weight and its effects on my life and health. Also I went back and recorded weight loss efforts, supervised and unsupervised (most were un supervised) like Weight Watchers (I didn't have all of the paperwork except for these last three months that I kept careful records with Weight Watchers) all this is being submitted with my package by the surgeons office and they seem to think it will be approved with no problems. My PCP is writing a detailed letter about her opinion that I should go through with the surgery after I proved to her that I had done my homework, lost 12lbs this spring with Weight Watchers, explained all of the step my surgeons was having me go through, then she was on board, horray!! Best of luck, I think five years means different things to different groups. Call whatever WLS surgeons group and ask them about your coverage, they have the most experience getting these approvals processed because it is their bread and butter income!
   — Sami U.

June 5, 2007
The five years is just to show you have been overweight that long (or it should be) That is easy to do by showing over how many years your weigh ins at the Dr. The monthly supervision of weight loss is a shorter time.
   — Donna O.

June 6, 2007
If your surgeon has an insurance specailist, call and talk to her/him. They would be able to help you. Also, try asking for a copy of your policy about WLS from your insurance company. Then go from there. Don't depend on your friends word of mouth. They may not have identical policies. If your insurance is trough employment, it may depend on what they ask to be covered. Good Luck. - Judy
   — jk_harris

June 7, 2007
I have Blue Cross Blue Shield of Texas and yes, the PPO does require 5 yrs of medical records documenting that you've been obese. This is actually something to celebrate. Two years ago their requirement was 10 years! (Because I've been checking on this whole WLS thing for SEVEN years!!!) If you've gone to the same doc for five years, which most have, (I haven't), it's easy. Just get your medical records. Everytime you go in, don't they weigh you, take your blood pressure, etc? Then your weight is right there in the records! Voila! Finished!
   — [Deactivated Member]