Horizon Blue Cross Blue Sheild Of New Jersey?

[Chris1982 2]

Cmon somebody out there has to have been aproved by this group at some point? I'm sure I'm not the only one here! Just want somebody elses experience with them, and if not then I will share mine soon// should be hearing something else any day now.:clap2: :clap2: :clap2: :clap2:

[Alexandra 55]

You have nothing to worry about if you are indeed medically qualified. This is the best carrier in the state for banding, according to my surgeons.

[LA chula27 0]

I was approved in 1 day with NJ b/c b/s. Good luck to you!!!

[cfready 0]

Hi La Chula,

I am very pleased to hear that you were able to get your band approved so quickly. I have BCBS of New Jersey and have not had the same success.

In fact, insurance stalled for 4 months before telling me that I had to start again and do a 6 month nutritional program among other requirements. When I first called, I was told the surgery was covered and there were no prerequisites.

I live in Houston, TX and when the surgeon's office contacted BCBS that is when all the stall tactics started.

I am wondering if I am better off going to NJ and having it done by a doctor's office that is already in good with BCBS of NJ.

What do you think? Who was your surgeon and how did you go about getting your approval?

Any info you can share is appreciated.

Thanks,

Cindy

[LA chula27 0]

HI Cindy,

My Dr. Was Dr. Samir Patel in Egg Harbor Twp Nj. And let me tell you no office will work as hard as this office to get approved. Liz who is the Pre cert lady @ Dr. Patel's was great with me and my sister who also had the band. She got me approved Quick. In one day. My advise will be if you can come to jersey and go to this office im telling they will get you approved. But form what Liz told me is that insurances are getting tougher and tougher to approve this surgeries, they requiere a whole history of diets and attempts. Can i ask you how much do you weight and your height, do you have any health problems?my BMI was only 41 and they got me approved and i have no other problems. Let me Know and good luck to you. Dr P's # is 609-926-5000. They are super nice in that office and Dr. P is the best around here.

[seppi 0]

I was approved in less than 3 days. My BMI was 40 and no other problems. They were quick, the only problem I had was after the fact with the anesthesiologist-not all was covered, usual and expected was very different than what was charged. Good luck.

[terrriho 0]

Interesting reading about the very different experiences with BCBS of New Jersey. I don't know if BCBS of New Jersey is the same as mine which is Horizon BCBS of New Jersey. However, I am scheduled to be banded Dec. 4 but still do not have approval from Horizon BCBSNJ. My surgeon's office said they had had one patient with this company and it took 9 months to get approval - the worst they had ever worked with they said. They would fax the info and the company would say they never got it so the office went to a return receipt mail option which apparently was the only way. So here I come, they send their first inquiry the end of Sept. I wait 3 weeks and call the company, nope, they don't have it but the office can fax it so the office faxes both the letter and the delivery confirmation. Wait a week, call again, well yea! they have it but it hadn't moved on from the initial receipt but I was assured they were "putting it on the network." I wait a week, call again, well it is on the network but no one seems to have taken any action (which apparently is a little strange) so I was told it was to be put on the "priority" network (surely it will move now:rolleyes: ). I call this week and guess what? Some how the "network" is down:faint: at the time of my call and I can't get any information but I was assured that something on the priority network should see action within 48 hours. OK so that was Wednesday and I will call again tomorrow to see if their "network" can give me any information.:rolleyes From my experience it seems like maybe I should have just gone to NJ (I live in Montana) and walked that letter through their system because that is really what I am doing. Initially when I called to see if the surgery was covered they said it was evaluated on a case by case basis. I have a BMI of 43 with high BP. I have yet to find out if I will be covered.

Again, interesting stories

Terri

[NJChick 3]

They approved me but jerked me around until 3 days before surgery... not nice thats for sure.