BCBC Horizon NJ

[New day ahead 40]

Anyone have the insurance BCBS Horizon? The phone inquiry I had was ridiculous. I called to see if the surgery would be covered and the girl on the end gave me such a run around! She said "bariatric (with emphasis on bariatric) surgery is not covered under your plan. I replied" really? I can't believe you would rather pay for years of diabetic complication, possible stroke or heart attack". Once again she repeated the statement. I said what about appealing and she said it again. No other words. I then was a bit perturbed by her attitude in her voice and had a few suggestions. To make a very long conversation short, I kept asking about the appeal process and in the end she said"bariatric surgery is not covered under you plan but if it is medically necessary it will fall under regular surgery". I said to her that would have been nice for you to tell me 15 minutes ago. I was so frustrated. Waiting to hear. Anyone else have this problem with insurance!

[Pinkgirl1234 761]

I have this plan...I am trying to get a revision from lap band to sleeve.All the doctors in our plan are located in South Jersey so I have to drive Aan hour and a half.You need to just approach it differently.Talk to your PCP...get a referral to a bariatric doctor...excuse me....surgeon in the plan....get ready to travel to Camden,Vineland,Cherry Hill or Voorhees NJ because those are the only areas approved.Dr.Patel,Dr.Attia,Dr.Salcone and a few others take our plan but you need to get a referral for a consult...Also plan a method of attack...keep records of your weight loss programs...hoops...

[New day ahead 40]

I live in PA but have NJ insurance. The good news is they called today to say I was approved! Woo hoo!! So my first appointment with the surgeon is 8/27.

[Pinkgirl1234 761]

So wait approved for surgery or approved to see a doctor?you called and got an approval or your PCP wrote you a referral to see a bariatric doctor.?

[New day ahead 40]

The surgery center called my insurance and said it was covered except for the $100 deductible. I was shocked after the conversation I had with the insurance girl a few days prior. Then they asked if I wanted to schedule my appointment with the doctor.

[Pinkgirl1234 761]

Yay!Who is your dr?I have Dr Goldstein.

[New day ahead 40]

Dr Ku. Are you in PA? I never heard of Dr. Goldman.

[Pinkgirl1234 761]

Dr.Adam Goldstein.I am in N J.Where did you have surgery?

[Pinkgirl1234 761]

Dr. Ku?What is the first name?

[New day ahead 40]

I have not had my surgery yet. It is Dr. James Ku.

[Pinkgirl1234 761]

Not in my plan horizon NJ Health