Question:
Please, all Texans, and otherwise knowledgeable persons,

Denied after submission of huge, and thorough submission of packet (letter of medical necessity 15 pages long and documented in immense detail). Ready to go forth to appeal exclusion that talks about "weight reduction programs, services, and equipment, even if physician says is necessary,and even if prescribed by physician." May not be able to get around it -wouldn't you know it, our open enrollment began at work yesterday July 15, 02 and runs through the end of the month. Scott and White Health Plan is the only one with the actual statement that they will cover, but, I don't remember seeing either of the two Doctors on this site that perform the surgery. Has anyone heard of and/or can give me some information on Dr. Richard Symmonds and Dr. Joaquin Rodriequez?? Dr. Rodriequez is ringing a bell, but I want to hear sound feedback before I even consider changing Insurance, and beginning again, even though the new plan will more than likely pay. Thanks so much. Pam Cerda    — pam C. (posted on July 17, 2002)

July 17, 2002
Where in Texas do you live? I am in Katy which is outside Houston and, have never heard of these doctors.
   — Deb K.

July 17, 2002
Are you a employee of the State of Texas? I'm DHS, and I was wondering about your situation. I don't have info on Symmonds or Rodriequez.
   — Lynda L.

July 17, 2002
If you are talking about Ted C. Scott in Lubbock, TX he is wonderful, his web site is newreflections.com he is at university medical center out of Texas Tech University. He did my surgery in March.
   — Tonjia L.

July 17, 2002
Did you check feedback on this site regarding the two doctors in question?
   — TexFlutterby

July 17, 2002
Dr. Symmonds and Dr Rodriguez are both officed in the Scott & White clinic in Temple. The web addy for Scott & WHite is www.sw.org. CLick on the obesity link to get to the info you are looking for. It has info on both docs and testimonials from patients. They just conducted a lecture on July 13, 2002 in Austin so not sure when the next one will be. You can email Paulette Whitfield for that info (link to her email addy on their site). They have a support group that meets twice a month. hope this helps. What county do you live in? You insurance carrier eligibiliy is based on the county you live or work in. There are specific exclusions written in the policy for both HealthSelect and HealthSelect Plus regarding treatment for obesity. The HMOs offered do cover treatment for obesity. Hope this helps.
   — Brenda H.

July 17, 2002
forgot to mention one thing in my earlier post. Your Open enrollment period doesn't end at the end of July. It runs thru August 23rd so that should give you a little more time to make a decision.
   — Brenda H.

July 22, 2002
Yep, I'm a state employee (TWC) but we don't have Scott & White coverage in San Antonio. I know Community First specifically says they won't cover it and I couldn't tell you if First Care does because they don't list their exclusions. It's funny you'd mention that though because I was just on the ERS website trying to figure out which one will be more likely to cover my revision if I should have to get one. Scott & White looks most likely to cover--at least according to their website. Good Luck!
   — Ms S.