I think I've finally been approved.

GrizGirl · April 29, 2005

Does perserverance really pay off? I guess I will know soon enough.

I have been wrangling with Horizon BC/BS of New Jersey since October 2004 trying to get approval.

I received a call from our company's benefits broker today. I had to involve our benefits broker because I was getting nowhere trying to deal with BC/BS directly. The last contact I had from BC/BS was January 27. At that time they requested two minor pieces of information that were forwarded by my surgeons office. I called BC/BS March 4 to see if any determination had been made. They said they had received the information requested January 27 and my case had gone back to utilization review, and it would be another 6-8 weeks before I heard anthing. I didn't sweat that too much because I knew that if I received approval, there would be a time frame of 30-45 days imposed, and I had a vacation scheduled for Mid-April and month end at work is hell.

When I got back from vacation I phoned my surgeons office (april 20). They hadn't heard anything from BC/BS--the lap band coordinator phoned them that day--BC/BS went on to request the same information that they requested in the letter of January 27. She kindly forwarded that on in addition to other information and results from some tests and procedures I had in the mean time.

Fast forward to today. I got a call from the benefits broker saying I was approved and a letter was mailed out yesterday, the only rub being was that my time frame for surgery had expired. My benefits broker is now dealing with this. Is this great or what?? What a roller coaster.

Iluvharleys · April 29, 2005

That is great news! Now you will have to let us know your surgery date!

La_madam · April 29, 2005

Great News, I hope you get a date for surgery soon. Let us know

GrizGirl · April 29, 2005

Hi La madam--

I wanted you to know that I've made you into my "poster child". When I first started lurking around this site (last fall) I took mental note of the "stats" you'd posted--If memory serves, I think I am about at the same height & weight now as you were when you began your journey. It's been nice to see your progress. I know if I can do half as well as you have and maintain such a healthy outlook and attitude as you I will have succeeded.

Sal

Alexandra · April 30, 2005

Good job, Sally! You're living proof that it takes perseverance to deal with the insurance carriers, but it does pay off. Horizon is really great about approving bariatric surgery, but they are hell when it comes to handling paperwork. I ALWAYS call to confirm that something has been received when I'm dealing with them; otherwise it gets lost in the miasma in Newark.

So you'll have a new date really soon. YAY!! And soon your countdown will begin...