BCBS NJ Direct

[aliceac 2]

I have a BMI of 40 I am jumping through all the hoops but I am so scared that my insurance will deny me. My doctors office saids I have a 95.5% chance of getting accepted. I did my pschy eval and nutrition eval both approved me. I have to go get the letter from my doctors office but she referred me for surgery so I know she will too. I am just so scared that because I dont have record of the weight loss program that will get denied. My doctors office saids my insurance doesnt require it. Has anyone experienced this ?

[dharriott 37]

With a BMI of 40 you should get approved. Just relax.. I felt nervous too. My surgery date is March 12th.

[aliceac 2]

Edited February 25, 2014 by aliceac

[aliceac 2]

With a BMI of 40 you should get approved. Just relax.. I felt nervous too. My surgery date is March 12th.

I am just so scared, I am ready for this suregry and I want it so bad. Im just scared theyll ask for teh 6 months thing after Ive gone through everything else.

[Daria 5]

I also have BCBS NJ Direct 15. My paperwork was submitted yesterday! I'm praying for an approval with a BMI of 37.5. I also have high blood pressure as a comorbidity. I feel you pain of waiting for a reply. Hope all goes well.

[JerseyGirl68 1,172]

I also have BCBS NJ, they used to require the 6 month supervised diet, but around August 2012 (when I was starting my process) they did away with that requirement. The coordinators at the surgical office typically are very on top of what is required. You have a good shot, best of luck!

[Nellarifixmom 5]

Hello! I'm new to BariatricPal. I've met with a surgeon and have just begun doing what I need to do to get my case ready for submission to NJ Direct. Unfortunately, my surgeon's office says that I have to find out what the criteria for approval is, but NJ Direct tells me that Utilization Management tells the provider the criteria, not the patient!!!!!!

Anyway, JerseyGirl68, there's really no diet requirement anymore? How about nutrition consults. I met someone who said that her insurance company requires three consults but that they each have to be 30 days apart.

Any suggestions?

Thanks!!

[aliceac 2]

Hello! I'm new to BariatricPal. I've met with a surgeon and have just begun doing what I need to do to get my case ready for submission to NJ Direct. Unfortunately, my surgeon's office says that I have to find out what the criteria for approval is, but NJ Direct tells me that Utilization Management tells the provider the criteria, not the patient!!!!!! Anyway, JerseyGirl68, there's really no diet requirement anymore? How about nutrition consults. I met someone who said that her insurance company requires three consults but that they each have to be 30 days apart. Any suggestions? Thanks!!

Yes I had the same issue every time I call they say they give my provider the details. I had to get a letter of nessecity, nutrition consult and a behavioral. That's all

[taylokat 180]

I have BCBS NJ Direct 15. My first surgical appt was January 2013 and my surgery was 4/12/13. I saw my surgeon once a month and I needed medical clearance, pulmonary and psych clearance. Diagnosed with sleep apnea on the pulmonary clearance. BMI 37. 11 months later I'm down 80 lbs!!!

[Daria 5]

I have BCBS Direct 15 of NJ and was approved yesterday! My surgeon and my nurse coordinator gave me a list of requirements to complete before they submitted my paperwork to the insurance company. I never spoke to the insurance company. Surgeons office did it all.

[Daria 5]

I have a BMI of 40 I am jumping through all the hoops but I am so scared that my insurance will deny me. My doctors office saids I have a 95.5% chance of getting accepted. I did my pschy eval and nutrition eval both approved me. I have to go get the letter from my doctors office but she referred me for surgery so I know she will too. I am just so scared that because I dont have record of the weight loss program that will get denied. My doctors office saids my insurance doesnt require it. Has anyone experienced this ?

My BMI is 37 with a comorbidity of high blood pressure and NJ BCBS Direct 15 approved me with no problem. Just got approval yesterday with a surgery date of March 26. Good luck and stay strong and motivated! ????

[Nellarifixmom 5]

Thanks for the information, everyone! Good luck with your sugery today, Daria!

[aliceac 2]

Im just so concerned because Im scheduled for the 28th and my doctors office still has not sent the paperwork.

[JerseyGirl68 1,172]

Hey there, sorry for my delayed response. For my plan, and I uderstand not all are equal, they did away with the 6 month supervised visits. I did have 2 nutrition consults prior to scheduling, as required by my insurance.

[aliceac 2]

Approved finally. The dr office didn't send the papers until last Tuesday.