Horizon Blue Cross & Blue Shield Insurance

[formerfatchick 1]

Hello All, I have HBCBS of NJ and I've already inqured as to their requirements for WLS approval and have been told the standard response that I need to :

• Have a BMI above 40
  
• Need doctors letter of medical necessity
  
• Need to have documentation of co-morbidities
  
• Need a psych consult & a nutritional consult
  
• Need 6 months of medically supervised diet & medical attempts.
  

I've pretty much have done all of that and am having my 1s surgical consult with Dr. Ren of NYU on Wednesday. I am just starting to get freaked out about what is my insurnace doesnt approve ??? :thumbup: I've been told that the reviewer for HBCBS is very moody and if shes having a bad day I'm screwed !!! Does anyone have any expereince with horizon and their approval process ?? What do I do if they dont approve ?? :smile2:

[wemdawg 0]

I also have Horizon Blue Cross Blue Shield of NJ and was just approved on the first try. I was also very worried about getting all the proper paperwork and heard several horror stories on being denied. Believe me, you do not have to worry about being denied. Our insurance does approve this type of surgery. If they do not on your first time, it really is not a DENIAL, it is just a pending of more information so they can make the APPROVAL decision. Chin up.. I hope this helps.

[formerfatchick 1]

wemmie76,

thanks for the encouragement ! I hope everything goes well, I've prety much followed all their requirements so I guess its a waiting game. How did you document your 6 month attempts ? How long did they take to approve from when you got your surgery date ?

thanks !!

[wemdawg 0]

I only did 3 months (3 times) of diet monitoring with my doctor and a corresponding 6 week nutrition class with a nutritionist. They call this the "multi-discipline" approach. My doctor sent in a letter with my family history, diet attempts and all weight history he had on me. The nutritionist sent in a letter with the exact diet I was on and all weekly weigh in's. Of course, I also sent them every personal weight history I could find in the past 5-6 years in a nice little spreadsheet with what kind of diet I was on for each date. Plus a copy of the CURVES diet and my whole CURVES exercise schedule for the 2006 year. It was probably over-kill, but it did the job and I didn't have to do the complete 6 months.

Once my surgeons office got all the paperwork from my appointments and me, they submitted the whole file to the insurance company, as well as a "dummy" surgery date to push it through fast. My surgeons office called me 6 days later telling me I was approved. :redface:

[formerfatchick 1]

Hey Wemmie76,

You see they never told me of that option when I called !!! They just mentioned the 6 months and the othe stuff !! I wish they would have told me about that route. So I went in for my sugical consult but I need to fix some stuff on my documentation since my dates arent exactly 30 + 1 days apart and I also need to get a 2007 and 2008 evidence of being obese during that time as well. So hopefully I can get all this squared away soon and the insurance taken care of !!!!

[wemdawg 0]

I was also informed that I needed to do a 6 month (consecutively) diet with my physician within the last 2 years. My surgeon's office said that they have got it approved before using the physician monitoring of 3 months in correspondence with Nutritionist classes. It worked for me!

Keep in mind that once you submit all your paperwork, the worst they can say is they need more information.

:tongue2: