Horizon BC/BS

[Tracyde730 7]

Dumb question I know, but....is they a shortcut around the 6 month doctor supervised weight plan that is required? How about a doctor that sees me once every 3 or 4 months and helps with the weight?

[gordonfamily3 0]

Sorry nope...as strick as insurnace companies are getting on WLS there are not any loop holes. Sorry!!!!

Hang in there it will be over before you know it.

[Jersey Boy 0]

I don't think so I've tryed, with Horizon BC/BS of NJ and they say there are no acceptions

[Angelica 1]

Thats not true. I am a living banded exception.

THis is what happened. Initally after my paperwork was sent in, I recieved a response about the 6 month diet plan. I decided that I would just give it a shot, and I called the Horizon, spoke with a manager who was incredibly rude, and unhelpful. She was lame.

At that point, after an hour and a half, i decided to contact my company rep for Horizon. She gave me some information about our patient advocate, and I wrote her a letter and faxed it to her. I specifically requested that my case be reviewed by the Medical Director, and that their supervisor had been really rude to me.

3 days later, my pre determination was approved. My pre certification wasnt. I called the insurance company, and a rep mistook that information and told me I was approved for everything. When my clinic found out I was not approved for the pre cert, they notified me, and I called the insurance company, got ANOTHER supervisor, and because they had already told me that I was approved, and noted it in my account, they had no choice but to approve me, I was banded 6 days later.

My point is this, there is ALWAYS wiggle room. Always. Start your diet thats medically supervised, and see if you cant get around it in some way.

[Jersey Boy 0]

Angelica, thanks for your response. I was told by my doctor's office that I could jeoperdize my ever getting approved, once being denied, if I tried and they got upset, or I pissed off the wrong person. (pardone my French) When my paperwork went in they held it for two weeks, then after they changed the requirements,and they denied my request. Before that we only needed a referall from the primary care, Psych eval, nutricianist, and cardiologist. I also have most of the co-morbidities that go with being obese, and morbidly obese, for a long time. I only worry now that if I loose weight on the six month diet and get too close to a BMI of 40 will they deny me again, or say I've lost weight on a diet and that I don't need the surgery. I know that I can loose some weight but, I can't keep it off.