Anyone approved with BCBS NJ after first being DENIED

[Monilove122 0]

Hi,

I was just told by the Doctor I planned on using that I was denied. I hadn't been to any visits or anything yet this was just the pre-approval. The Insurance person said usually when they are told it's Denied up front it's because it's excluded from my coverage. But, she told me to call and ask questions.

Has anyone been in this predicament and been approved? If so, can you offer some advice/assistance.

TIA for any help offered.

[LISAMARIE1158 0]

perhaps you should call and ask if your plan covers the procedure..If they don't cover it, you'll never get approved. l was denied the first time around, but only bec by Insurance info wasn't complete..a totally different senerio than your

[ayyypapi 0]

I have BCBS Anthem. I used to have regular BCBS I guess? I am not sure but just last year when I inquired about the lapband they told me that it would not be covered and they would only do bypass if necessary. Then our plan upgraded or something to anthem and now they cover it and lessened some of the requirements. I don't really know too much about insurance seeing as its on my dad's plan but maybe try calling them and asking them about it and why it wouldn't be covered might work. I heard stories about just the way you ask or what codes the doctors use can be a huge difference in them saying yes or no.

[Monilove122 0]

Thanks for responding. In speaking to the Patient Rep she said she was told it was not covered at all and was excluded in my coverage but that I should call and see for myself as she's been told that in the past but when the insured called they were told they were denied.

I'm going to call when I leave work as I don't want people in my business.

But, my other question is that I am on really good terms with the HR rep for my company and I'm wondering if I should mention something to her once I find out what's going on...

[10bluetoes 0]

Hello! I have BCBS-NJ and was just approved last week for lap-band. It took them almost 2 months to review & answer, but it was approved.

I believe it does have to do with what your company may have specifically included/excluded in your benefits.

[BLKsAunt 0]

I have Horizon BCBS. has anyone had to submitt notes from WW

Documentation of successful completion of at least 6 consecutive months of supervised conservative weight loss program, diet programs/plans (e.g., Weight Watchers, Jenny Craig), or the Horizon Obesity Disease Management Program.

Successful completion means formal documentation or photocopies/print-outs of progress notes of at least monthly follow-up by the supervising physician, other health care provider, or program coordinator including the patient’s weight and progress relative to the goals set at the start of the program.

(NOTE: Pre-printed check-off forms and summary letters are NOT acceptable documentation for this requirement.)