Horizon BCBS of NJ Reject

[stomaszewski 0]

<p>I need to vent, big time! I am flipping out here!! I have been done all of my procedures and waiting for approval since...ready?...MARCH 9th!!! I want to scream about the 2 months of one ridiculous incompetency after another, between my docs office and the health insurance...I've been the only person working!! I AM FURIOUS! <img src="http://www.LapBandTalk.com/images/smilies/mad.gif" border="0" alt="" title="Mad" smilieid="9" class="inlineimg" /> </p> <p> </p> <p>Now I found out today that I've been rejected because Horizon needs 5+ years of morbid obesity. Not that easy to get med records from 5 years ago, especially because I've moved since then. My BMI was 39.5 ... would I even be going through all of this because of a lousy .5?!!</p> <p> </p> <p>What do I do now? How can I appeal and win? I've put so much time and effort and research into this. </p> <p> </p> <p>I'm just feeling so dejected right now and angry...someone needs to be accountable for this. We patients should not have to be put through the ringer like this!</p> <p> </p> <p>Help? </p> <p> </p> <p>Steph T. <img src="http://www.LapBandTalk.com/images/smilies/depressed.gif" border="0" alt="" title="cry" smilieid="49" class="inlineimg" /></p>

[Frustrated 1]

Hi stomaszewski,

I just joined today and as you can see, I'm Frustrated. In more ways than one. My insurance company also rejected me last week. My weight was too low by .1 (if you can believe that). I was also claiming that I had comorbidity issues (diabetes), but was told I wasn't being medicated enough for it. I was also told that my elected surgeon missed the cut-off point for a peer-to-peer interview. They'd called him 2 hours before the office closed for the weekend and expected to hear back from him before close of day. However, there's a time difference between our insurance company's office (California) and where me and my surgeon's office is located (Texas).

My surgeon managed to sort out the peer-to-peer issue, but now I have to deal with the other issues myself. I guess.

I was horrified when I was told I wasn't unhealthy enough, and that I wasn't obese enough. I've been working my tail off unsuccessfully for what seems like half my life to permanently lose this weight, only to be told my surgery is not medically necessary. What am I to do to try to avoid other medical necessities in the future? It's like I'm being punished for trying to avoid further health risks.

Hope you don't mind me jumping on your soapbox and having my own little rant. I know it doesn't help solve any of our problems, but it's somehow comforting to know there's someone else who shares my pain and frustration. :angry

[lisanjason 0]

This is the exact reason I took my credit card and went to Dr Kuri in Mexico!! I was so sick of dealing with my insurance company and having them run my life and keeping me under thier control by telling me "NO" I finally decided to take control of my own destiny and just do it on my own! Good luck ladies!!

[Snaggletooth 0]

If this is the first time you've been denied....keep fighting! Sometimes it seems they deny with the hope you will give up. Remember bugging your mom when you wanted something ? You kept on bugging her till she said Ok.

Hang in there, keep trying. Good luck to you.