The Insurance Story
The first time I tried to get the surgery we were with HMO Blue. My PCP (Primary Care Physician) put in a referral for me and it was rejected because it was not a covered procedure. He tried again and wrote a letter. They said NO! with a nice letter. Two down and it was my turn to write a letter. My PCP suggested that I get the surgeon to write a letter, but the surgeon's office person said that without a referral, there was no way insurance would ever pay. My PCP said it was useless with this insurance company because they had an iron clad exclusion in their policy. He suggested we change insurance companies. The next open enrollment period we did.
Now we were with a Blue Cross Blue Shield of Texas PPO through my wife's employer. My PCP suggested I try getting my endocrinologist to help me. Now my endocrinologist's office is not as easy to work with as my PCP's office. In fact if they were not the best people in town I would look for a different doctor. The person who was supposed to write the letter and dicker with the insurance company was too busy to bother with it very much. After many phone calls and only speaking with a receptionist the first and second letter was sent and rejected. Again BCBS of Texas PPO refused the referral on the grounds that the surgeons were not on their list.
After two failed attempts I was resigned to fact that if I wanted this operation I would have to pay for it myself. Then along came high speed internet to save the day.
My wife and I had internet access for a couple of years but it was not practical for extensive surfing (information gathering). When we got high speed access it just seemed to open up new worlds of information. We discovered all sorts of informative web sites about WLS. I stumbled across people who had the TRC (Texas Rehabilitation Commission) pay for the operation. One person was even kind enough to email me copies of the letters she used to get them to approve her case. (I found my letters there is link for them at the bottom of the page) The only problem was that everyone said TRC would take 12 to 18 months to approve my case if I was even eligible. I thought I probably wouldn't be eligible because I was employed and had health insurance. I was discouraged before I could even try.
While all of these battles were taking place I was still busy researching a procedure, a doctor, and a support group. I lucked out and found a great one right here in San Antonio. During our first support group meeting a wonderful person whom I met online suggested we try the TRC anyway. She said the TRC was in the business of keeping people employed too and not to give up hope. This started the thinking process unfortunately not the process itself, that took someone really special for it to happen.