does anyone here live in nj with horizon bcbs

[barblox 24]

I am in desperate need of a doctor that will do a complete Tummy Tuck and have it completely covered under my insurance and isn't afraid to fight for it

[vsginnj 415]

I'm in jersey with bcns horizon my approval letter for vsg congratulated my for wanting to get healthy and said something like "be advised bariatric surgery often leads to excess skin that we don't pay to remove" so basically "tummy tuck" removal of skin and lacing abdominal muscles is out, if you have medically documented skin infections in areas where skin hangs they will consider a lesser procedure that removes the skin apron but no internal work. My surgeon has a list of locals who do these procedures.

[barblox 24]

Thank you for your reply

[AprilKeepingItOff 33]

Did either of you have a problem with getting approved? My bmi is

35 and my nutritionist said if I lose anymore weight bcbs won't approve me

[gigi2195 4]

I am also in NJ and had a slight issue getting approved. I got denied because my bmi was only 36 but since I have so many metabolic disorders (high blood pressure, diabetes and heart issues) both my primary doctor and my surgeon appealed the denial and I got approved. The only thing was that the insurance required for me to be monitored by a nutritionist and had to be weighed in for three months. I had the sleeve done in November.

[jrsygrl0520 19]

Direct access i have 100 percent they cover my gf got a bill from clara maass though totaling 40000

[gigi2195 4]

@Jrsygrl0520....Clara Maass is really close to where I live. Are you from this area?

If your insurance covers it at 100% you should call the insurance and question them about it. Hospitals don't always bill correctly.

[JerseyGirl68 1,172]

Hello fellow Jersey Girls! I also have HBCBS NJ, for my sleeve they covered 80%, after my $2500 deductible. They also let me know when I was approved that they don't cover costs to remove the excess skin. There are other procedures that are sometimes covered, but its a struggle.

[vsginnj 415]

I can see Clara mass from my house, I have Bcbs horizon I used dr Strom at mountianside I paid him 25.00 co pay and some copays for pre op clearance my total out of pocket was 150. He told me at initial consult I would not get another bill and if I did give it to him I never got another bill. My BMi was 36 with no comorbidity and was approved first try

[jrsygrl0520 19]

Im from east rutherford yes i am girls hi i work there dr balleem was my dr there got treat well have bcbs direct access they cover a 100 percent my friend who works with me also got a 40000 dollar bill not sure what that is about

[jrsygrl0520 19]

My bmi is 44 im sw 236 now 215 had surgery jan 2

[gigi2195 4]

Wow we all live so close by. I'm in North Arlington and I have family in East Rutherford, Bloomfield and Belleville (right by Clara Maass).

My bmi was 36 too and I had to appeal my first denial and wait 3 months before surgery.

[jrsygrl0520 19]

Oh how old are you im 26 how much was your st weight mine was 236

[gigi2195 4]

Oh how old are you im 26 how much was your st weight mine was 236

My weight at my day of surgery (which also was my highest weight) was 228 and I'm 37.

[jerzh0tty 1]

Hey Ladies local girl here... I am waiting to see if my insurance covers ... I am very new at this and praying to god Horizon bcbs direct access approves me so I can have my first appointment. In the meantime i'm reading up on everything I should know!