BC/BS of New Jersey

Angelica · August 28, 2007

Hello all

I have just filled out initial paperwork for the lapband surgery. I was weighed, and had my height measured at a Center for Excellence Hospital in El Paso, TX. I was told that my medical records would be requested from my doctor, then the surgeon would write a Letter of Medical Necessity to my insurance company, Blue Cross Blue Shield of New Jersey (I know what youre probably thinking, what is a girl in Texas doing with BCBS of Jersey, but my company has many offices around the country, and everyone gets the same insurance). After that, there would be consultations with various health care professionals, and there would be a whole lotta testin' going on.

I called BSBC, they told me I was covered at 100% for the procedure, with a 100 dollar co-pay for every night I would spend in the Hospital. I was also told for a 'pre-determiniation' from the insurance company, it would take 7-14 business days. This all seems rather reasonable, however, I was just wondering if anyone has experience with BS/BC of Jersey, and how their approval process goes, time frames and whatnot.

I am currently (as of today) 295.4 LBS and 5'7. I dont have many major health issues, but I am fairly young (25). How would these contributing factors effect the approval/denial process?

I appreciate the response!

-A

jetti · August 28, 2007

Angelica

I also have BC/BS NJ and I am currently trying to go through all the steps to get approved to be banded. I call then insurance company today and they told me that I have to have pre authorization and any requirement would be given to my dr at that time. I do know that most insurance companies require 6 months of a doctor supervised weight loss plan, an MRI of neck and back and a phyc evaluation. I am sure there are more things but those are the only ones I know of right now. I have tried to get most of this done before I pick a surgeon and go for a consult in hopes that I can try to be "ahead" of the game. As for as I know they do not require you do have any other health issues besides the high BMI.

Good luck with your approval and your surgery and if you get any other info on BC/BS NJ please post it.

NJChick · August 31, 2007

I have BC/BS of NJ. They told me all the steps necessary to get approved and then gave me a hard time once I had done everything done. They pulled the crap...oh we didn't receive any paperwork from your surgeon. To make a long story short, I was on the phone every day with them until two days before my surgery date...thats when they approved it. I was on the phone in tears day after day. Talk about stress and hopefully they won't do that to you...but be ready.

My advice to you is to call them, daily if you have to. Never assume things are going along smoothly. Get a diary and write down names, dates and times you spoke to each insurance person. Get a manager on the phone if you have to. They will tell you they will call you back, when in fact they don't. If you don't hear from them in 24 hours...YOU call them back. If they pull crap with you and they do have your records tell them you want a "48 hour expedited review" when you say this, they will have your answer in 2 days.... for some reason this is like a secret code ??

Don't rest until you have an approval number... or your surgeon has that approval number.

Also make sure the hospital has that number.....just to make things smoother.

I don't want to scare you because maybe things will go along smoother than when I had to deal with it....but at the same time, I wanted to make you aware of what they are capable of doing.

Good luck ladies

Jaculin412 · August 12, 2008

Has anyone from NJ used Dr. Borao with surgery being at Monmouth Medical, Long Branch?

MiniBand · August 12, 2008

I submitted my packet in July around the 21st to BCBS of NJ. I called yesterday and the first guy said they didn't have the packet. They transferred me and the second guy told me it was under review. He said a standard review takes up to 30 days and could take longer. The pre-authorization people can't help you, it was the member number I spoke to the second guy.

The very first time I called I was told, oh its covered blah blah blah... and I timidly asked what the requirements were and the person was like on there's not any just ask and see what happens. Seriously I knew that wasn't correct but seriously sometimes I think they just say what they think you want to hear.

In the meantime I have started an exercise regime and I'll go to my Dr. by the end of the month to keep going with my supervised visits if I have to.

missnikkie0514 · August 13, 2008

I have BCBS-NJ and I submitted my paperwork to them on 7/29/08 via fax to a supervisor I had been dealing with. I was told it would take 7-10 business days since they were marking it priority. Well it actually took 2 weeks to the date and I was calling everyday for the last 4 days. I am glad to say I was APPROVED!!!