Horizon nj direct

[stephanie0456 38]

Hey everyone, I've been reading alot on this insurance topic but havnt seen much about horiZon nj direct access.... Just wondering if anyone had some info for what they require. I called my insurance and all they said was I just need a letter of medical necessity and pre auth.... I am 5"3 about 210... I have pcos arthritis and very high blood pressure, my surgeon said I was a good candidate but I'm nervous about the approval process. I already did my upper ugi swollow study saw the psych, the nutritionist, a pulmonoligist and my regular dr. I have an appt on Monday with my surgeon again. I'm wondering if they will send my stuff to the insurance at that time? Any help from you guys would be greatly appreciated!

[can_do 195]

I also have NJ Direct. I was approved in several days from the time the office sent in the required documentation. From my very first consultation with the surgeon to my surgery was about 6 weeks total.

[stephanie0456 38]

Wow that's really quick! I hope mine goes as smoothly as yours! What were the requirements? When I called them they didn't mention anything about 6 month weigh ins or 5 yrs weight history or all that other stuff other insurances are requiring

[can_do 195]

My doctor's office staff took care of all of it. They were familiar with NJ Direct and knew the routine. I also have hypertension, bad knees and other co-morbidities. They required nothing else from me except the psych and nutrition evals. Where are you located? Who's doing your surgery?

[stephanie0456 38]

I live in nj, monmouth county... My surgeon is dr kipnis... He's affiliated with jersey shore... The insurance process for us seems pretty simple, I guess I'm making myself so stressed about getting approval just because the requirements seem to good to be true, if that makes sense! Lol

[can_do 195]

You know, they may have already done the submission. Mine was sent the day I went for my psych and nutrition eval. Maybe you'll be pleasantly surprised on Monday.

[stephanie0456 38]

Maybe! I'm just Gona try and not think about it! Lol where are you from? And which dr? My only problem I have with the staff and it's not a huge issue was that they had me get everything from all the drs instead of them. Like the letters and everything, I mean I wasn't sure exactly what they wanted so it was hard to get exactly everything, but I faxed all the papers last week so hopefully they have what they need! Lol

[can_do 195]

I'm in Warren County, out near the PA border. I did however, travel to Engelwood Hopsital to have my surgery done by Dr. Pucci, because I felt he and his partners are extremely experienced. I had a great experience and continue my follow up with them in their Denville office. I couldn't be happier with them and the office staff. I'll pray that everything goes smoothly for you. Send me a private message if you want to stay in touch.

[stephanie0456 38]

Thanks, I'd like to keep in touch I'm not sure how to send private messages

[can_do 195]

Just click on my photo to get to my page. You'll see a button there to send messages.

[megamomnj 334]

To Stephanie- I had NJ Direct at the time of my surgery in November. My BMI was 37 but I had sleep apnea. They did require me to check in with my primary care doctor for three months for a weight check. It took about a week to be approved once all the paperwork was submitted but they told me it could take up to two weeks. Message me if you have any questions!

To can_do - where do you live? I am in South Jersey now in Medford but grew up in Washington in Warren County.

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[can_do 195]

To Stephanie- I had NJ Direct at the time of my surgery in November. My BMI was 37 but I had sleep apnea. They did require me to check in with my primary care doctor for three months for a weight check. It took about a week to be approved once all the paperwork was submitted but they told me it could take up to two weeks. Message me if you have any questions!

To can_do - where do you live? I am in South Jersey now in Medford but grew up in Washington in Warren County.

Sent from my iPhone using LapBandTalk

I'm in Knowlton Township, Columbia, just south of Blairstown.

[megamomnj 334]

I know exactly where that is! Good luck with everything. When did you have surgery!

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[can_do 195]

Megan,

I had my surgery on February 4th. I chose to go all the way to Englewood Hospital because I felt I wanted very experienced surgeons. I'm pleased, so far, with everything. I see you've done very well! Congratulations.

[megamomnj 334]

Thanks! I am feeling great. While I would love to loose another 20 lbs I would be happy to weight less than 180 lbs for the rest of my life!

Good luck to you!

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