Horizon NJ Health, 12 month wait?

[mrsbailey921 117]

hi thick n thin and thanks! I am happy to report after MUCH digging and research I have found a doctor in northern nj (NOT my previous doctor) in Hudson county who performs bariatric surgery and accepts HNJHealth. His name is dr. jordan garrison. I do not have to leave my city for my surgery! 1/15 I have my seminar appointment and we will take it from there. I am so excited!

Hi! I also have Horizon Nj Health. I am going for my consult on the 28th with Dr. Neff (yay!). Just curious about what the insurance company requirements for the surgery are. Do the require 3, 6, or 12 months? And any other medical requirements? Thanks!

do they require 3, 6 or 12 months of what?

[mrsbailey921 117]

they do not require a supervised diet HOWEVER new rules state you must now have 5 nutritional visits 2 weeks apart. so altogether that's about 3 months of nutritional counseling. they will not give you any trouble with approving surgery so long as all of their requirements are met properly the first time around. this is why it's important to make sure you follow all rules and regulations and have doctors and specialists that will follow them also.

[Ariellestarr 53]

Thanks for the info. The surgeon's office had told me I only need one visit for each, so I better double check on that. It seems like the insurance company changed a lot of their regulations, making it easier to get through everything and get a surgery date. Does anyone know if the upper GI was mandatory?

[Thick'n'Thin 171]

they do not require a supervised diet HOWEVER new rules state you must now have 5 nutritional visits 2 weeks apart. so altogether that's about 3 months of nutritional counseling. they will not give you any trouble with approving surgery so long as all of their requirements are met properly the first time around. this is why it's important to make sure you follow all rules and regulations and have doctors and specialists that will follow them also.

When did they chance that rule? In December I was sleeved and only one preop nutritionist appointment was required.

[Thick'n'Thin 171]

Thank you so much! Did you have any trouble with them approving the surgery? Which surgeon did you go to? I don't have any co-morbidities that I know of (aside from chronic asthma). I hope they don't give me too much trouble. It's so hard to find info about Horizon NJ Health online. I appreciate any other info you have/think I should know. I just had my consult last week with Dr. Neff. I feel like there's so much I need to know and forget to ask!

I did bnot have trouble being approved. I had no comorbidities but had a BMI of almost 50. But if you have a BMI of 40, and (perhaps) if you've had a BMI over 40 for a period of time (five years?) you should be good. Horizon and the surgeon had me get a weight history for five years from my primary.

I got the sleeve. I personally wouldn't get your info from Horizon yourself. When I spoke to them I was misinformed by a CS rep. They told me I needed 1 year supervised diet! Totally untrue. Lori in Neff's office is very knowledgeable of how to get you approved, she's done it many times before. She will be your advocate with Horizon, trust her:)

If you'd like to talk on the phone about it PM me your number.

[Thick'n'Thin 171]

Thanks for the info. The surgeon's office had told me I only need one visit for each, so I better double check on that. It seems like the insurance company changed a lot of their regulations, making it easier to get through everything and get a surgery date. Does anyone know if the upper GI was mandatory?

Lori is correct. But if you find yourself second guessing just give her a buzz and ask questions, she can tell you whats up. Yes, you will need a swallow study. I drank dye and went under a flourascope. It was neat! I saw myself (my skeleton and muscle) swallowing. It was trippy!

[Ariellestarr 53]

Lol sounds cool! My only issue is I haven't been going to my pcp for five years. Hopefully I don't have to do that! I found a nutritionist that takes my insurance. I just don't know what I will need from him for clearance. I'm having a hard time getting in touch with Lori.

On a side note, I love this little community of WLS people! Everyone is so helpful and informative. Just here to help each other and guide each other on this long, exciting journey.

[HealthynHappy 3]

Hello everyone in this wls community I recently have jheoinedhello my name is nicole

[HealthynHappy 3]

Lol typing error ill try this again my name is Nicole I am new to this wls community and love the support from all the wonderful people here. You all answered so many questions from just reading the posts here. I am hoping to have the vsg done just has 2nd consult first was with goldstein 2nd was with Dr. Wasser and my 3rd is on the 14th with Dr. Rohit Patel! I have horizon nj health. Any opinions about any of these Dr's? Also did anyone have to do a 3mth nutrition visit? One office told me yes but the other no and the insurance also said no but they change so much! Thank you to all for takingnthe time to read have a great day! And keep motivated!!!

[Ariellestarr 53]

Lol typing error ill try this again my name is Nicole I am new to this wls community and love the support from all the wonderful people here. You all answered so many questions from just reading the posts here. I am hoping to have the vsg done just has 2nd consult first was with goldstein 2nd was with Dr. Wasser and my 3rd is on the 14th with Dr. Rohit Patel! I have horizon nj health. Any opinions about any of these Dr's? Also did anyone have to do a 3mth nutrition visit? One office told me yes but the other no and the insurance also said no but they change so much! Thank you to all for takingnthe time to read have a great day! And keep motivated!!!

Hey Nicole! Welcome. I am new here also. Everyone is so helpful and wonderful on here. You can find most answers to your questions just withing these forums.

I am seeing Dr. Neff and I absolutely adore him. His bariatric specialist, Lori, informed me that I only need one visit with each specialist, unless noted or necessary. I also have Horizon NJ Health. Did you get a packet of requirements for your insurance? I'm lucky enough to have found a nutritionist that takes my insurance. He's in Ocean Township. Not far from me, but probably a little bit of a hike for you.

Just a passing thought while writing this: it's really nice being able to assist someone else after all the help I've received from the community!

[HealthynHappy 3]

Hey thanks for getting back to me I wrote down the requirements from insurance hut never a packet. Im also going to dr. Fried I think hes also in ocean for my nutritionist visit luckily its covered cause I have 3 I have to go to I found out called coordinator again to see if she found out and she told me I was right but he still wants me to go to 3 but can be done in a month or whenever doesnt have to be 1 a month for 3 mths! I been researching vsg for months now im ready so im glad I dont have the 3mth wait! Im hoping I van get all paperwork in for june surgery! Donu have a date? U excited?

[mrsbailey921 117]

I would definitely recheck for the nutritionist appointments. the changes that I know of would have taken effect January 1st especially under the new obamacare requirements. I am speaking of this because changes have also been made to my dental plan as well as the DME and medications list. for instance, HNJH USED to cover supplements post op--they no longer do. and they also NOW cover humidifiers effective Jan 1st, when previously they didn't.

small changes mean big things for us.

I went today for my 2nd nutritional appointment, and yup...I was told that I have to have 3 more. it really isn't a big deal for me because I plan on attending the nutrional sessions regularly for as long as I can (at least until 1 year post op). we do both individual and group sessions so it is truly an awesome experience.

also, for me, since the time to complete my checklist is taking a bit longer than originally expected, I can fit in WAY more than 5 nutritional visits lol.

[mrsbailey921 117]

also, a requirement everyone has told me is...each nutritional visit has to be at least 2 weeks apart. so I am not sure how 3 visits in 1 month would be approved by insurance? HealthyNHappy please keep me updated on how that works out for you! id definitely like to know if it works out fine!

[Ariellestarr 53]

Hey thanks for getting back to me I wrote down the requirements from insurance hut never a packet. Im also going to dr. Fried I think hes also in ocean for my nutritionist visit luckily its covered cause I have 3 I have to go to I found out called coordinator again to see if she found out and she told me I was right but he still wants me to go to 3 but can be done in a month or whenever doesnt have to be 1 a month for 3 mths! I been researching vsg for months now im ready so im glad I dont have the 3mth wait! Im hoping I van get all paperwork in for june surgery! Donu have a date? U excited?

Have you seen Dr. Fried yet? He sounded a little kooky on the phone and didn't really know what to do. I have my appointment on Monday with him. I'll have to double check on the three visits just to be safe! I have heard something similar to what mrsbailey said. I've managed to make all my appointments before my second visit with the surgeon, so I'm hoping he will give me a surgery date then! I'm hoping for June. How many visits did you have with the surgeon before you got your date?

[HealthynHappy 3]

I dont have a date at all I just had a consultjust made all appts and last appt is 5-22-14 so im hoping they will submit it around then so I can be scheduled in june also! I know im jumping the gun but Im limited with time and that monthnis perfect for me to take some time off!