Horizon NJ Health, 12 month wait?

[Thick'n'Thin 171]

Hello all, I am new here. My PCP broached the subject of bariatric surgery recently. I am pretty interested. Has anyone dealt with this insurance company recently and bariatric surgery? When I called they told me the first step is to do 12 months of a documented weight loss program before anything else related to surgery. Timing wise, I found this a bit discouraging- as I have time intensive goals next september. Anyone have experience going through Horizon NJ Health? Thanks.

[Thick'n'Thin 171]

UPDATE: I'm so relieved after calling Dr,Goldstein's office (with Virtua/Kennedy) in Voorhees, NJ. I called him because he accepts Horizon NJ Health. I spoke with the coordinator and she assured me that there is no 12 month wait, that the operator at the insurance company is reading from a manual that is not current, and then incorrectly interpreting what the writing means as they relate it to me.

She told me that first I need to attend a seminar (October 9) before I can have a consult. Said I will additionally need a recommendation from my primary, nutritionist consult, psych consult, five year weight history from my PCP, any record of gym membership in the last year (which I have). I asked if I can start this now with the primary, before the seminar, in order to not waste time. She said yes. I have an appointment with my PCP, who recommended the surgery in the first place, on Monday!

I'm so excited. I look forward to and am motivated to getting into my best shape before surgery.

On a related note:Groupon just posted a great deal on Curves that can get me 20 visits for $39. I think, considering my level of (un)fitness that this may be a beneficial gym to join.

[NJ mom of 4 20]

Hi.... Your dr is my Dr too!! I just wanted to introduce myself and let you know .... Maybe we can be support to each other....

[Thick'n'Thin 171]

Hi.... Your dr is my Dr too!! I just wanted to introduce myself and let you know .... Maybe we can be support to each other....

Hello You are using Dr.Goldstein also? I see Dr.Attia listed as your surgeon. Either way I'd love to talk. I'm contemplating changing surgeons, Attia is on my list. Did you have your surgery yet?

[elhudge 69]

I have Dr. Attia. He is wonderful. Sleeve date 12/16.

[NJ mom of 4 20]

I had Dr Attia when I started a year ago... But then I started working again and couldn't make all my appointments so I stopped... When I started up again in August I went with Dr Goldstein because I had to switch from HorizonNj Health to United Health Care because CHOP didn't take Horizon and my daughter had to have surgery.... And SJHC doesn't take United.... So I switched.... I like Dr Goldstein and Dr Attia...I feel more comfortable with D Goldstein than I did with Dr Attia....

[Thick'n'Thin 171]

I have Dr. Attia. He is wonderful. Sleeve date 12/16.

Hello! How long was the process with Attia if I may ask?

[Thick'n'Thin 171]

Do you mind if I ask why you feel more confortable with Goldstein? Do you have a surgery date? I have my consult on Oct 28, after attending the seminar. Only thing is- Goldstein seems to push lapband. I am curious how many sleeve's he has performed compared to other doctors. I listened to a radio interview from Nov 2011 that he did, where it sounded like he only performed Banding at that time.

He sounds like a competent, skilled surgeon. Just not sure how supportive he is of VSG and how practiced he is.

I'd love to hear more about your experience.

[elhudge 69]

I started in April i was finished my insurance requirements by July. I was denied initially because I was not on meds for my comorbidities. (Low bmi). I appealed and won in early September. I scheduled my surgery in December, they had dates that were sooner.

[Thick'n'Thin 171]

I started in April i was finished my insurance requirements by July. I was denied initially because I was not on meds for my comorbidities. (Low bmi). I appealed and won in early September. I scheduled my surgery in December, they had dates that were sooner.

Thanks for sharing, and good luck to you!

[elhudge 69]

Thanks and your welcome.

[NJ mom of 4 20]

ThickNThin.... Who is doing your psych consult.... I am having a hard time finding someone... If you don't mind my asking??

[Thick'n'Thin 171]

ThickNThin.... Who is doing your psych consult.... I am having a hard time finding someone... If you don't mind my asking??

A Better Tomorrow in Millville- 856-776-7211

She charges a flat $150 for the evaluation. I believe you fill out a long questionnaire, she talked with you a while, and it takes about a week for the clearance to be mailed to your surgeon.

[Tashana03 5]

Hi. I had my initial appointment with Dr. Goldstein on 5-30-13. From his seminars, it is clear he favors Lab Band, but he does Sleeves also. I completed my check list around the end of August, my insurance (Horizon NJ Health, plan D) approved my surgery on the first request. My Sleeved is scheduled for 11-19-13. My insurance covered everything except for the nutritionist and Physc clearance. I'm both excited and nervous. After my last appointment with Dr. Goldstein he really made me fill at ease and I trust him as my surgeon.

[Thick'n'Thin 171]

Hi. I had my initial appointment with Dr. Goldstein on 5-30-13. From his seminars, it is clear he favors Lab Band, but he does Sleeves also. I completed my check list around the end of August, my insurance (Horizon NJ Health, plan D) approved my surgery on the first request. My Sleeved is scheduled for 11-19-13. My insurance covered everything except for the nutritionist and Physc clearance. I'm both excited and nervous. After my last appointment with Dr. Goldstein he really made me fill at ease and I trust him as my surgeon.

Hello! Thanks for the feedback. Horizon NJ Health doesn't cover the nutrition consult? That's crazy, since it's required! Do you mind if I ask you a few questions. I think it would be very helpful since you are using the same doc, with the same insurance plan as I am.

What preop requirements did the doc and/or insurance have?

Could you have completed the checklist faster and gotten a surgery date faster?

I'm hoping to have surgery after this semester ends, and before the next- so around Dec 19 if possible.

Was the doc supportive of your preference for VSG over banding?

Thanks