Horizon BCBS (PPO)

[Susan0784 0]

Hello all, I used these boards a lot to ease my mind when I was getting closer to my information being submitted for insurance approval, so I just wanted to share some information with all of you.

For those of you with Horizon Blue Cross Blue Shield, they used to require 6 monthly visits, at least 30 days apart before your surgery could be submitted for insurance approval, they now require only 3 (they changed this rule in December 2010). Your initial consulatation visit with your surgeon does not count in these visits, it is 3 visits in addition. BCBS also requires a letter of medical necessity from your primary care provider, a one-time psychological evaluation letter, and a one-time nurtritional evalutation letter.

As for a time line, I don't know if mine is the norm, but my packet was submitted for insurance approval by my surgeon's office on Monday, March 21st. I received the phone call from my surgeon's office that it was approved by insurance on Monday, March 28th, so that's exactly one week, I couldn't believe it! I've seen turn around times for BCBS on this board from 2 weeks to 2 months so I was shocked and relieved at the same time.

My surgery is scheduled for April 6th! Hope some of this information may have helped those of you that have this insurance and are in the pre-surgery, insurance approval waiting period