Hi,

My first time here. I was wondering if anyone has dealt with BCBS of NJ. I am going through the 6 month diet period. My doctor has already wrote the letter of recommendation saying I'm pre-diabetic, my family history, my weight history, etc. etc. I think the only exception is that you have to be morbidly obese which I am by about one pound. I hope I don't lose one pound and then the insurance deny me because now I am no longer morbidly obese. I hope I don't go through all this and then they deny me. Any advice would be great.

Niecey

I dont have BCBS of New Jersey but I do have BCBS and I will offer you some advice! Read your insurance companies policies on surgical management of morbid obesity. It will tell you everything you need to do and will need to get! DOCUMENTATION IS IMPORTANT!!!

STAY on top of ppl do not TRUST that someone is actually doing their job!! On paper look like youre doing everything you can to lose weight but if you really want the surgery...dont lose any weight!! Good luck to you and remember the insurance company wants a lot out of you so that you will give up so dont give up!!!!!

Thanks for the advice. I have actually gained weight because I quit smoking. I was afraid I would get ready and the doc would not do the surgery if I smoked. I gained 15 pounds in the process. GREAT just what I needed. At least I have a good reason.

I have Horizon BCBS of New Jersey I had to do 6 months of dieting and now waiting for insurance co. approval . The Dr. told me that they go by your starting weight not your weight after the 6 months of dieting . He said even if I lost 30 lbs. and was no longer morbidly obese I would still get the band and be 30 lbs ahead .

It the seminar (Abkin Bertha in north Jersey) I was told that BCBS was not bad but if you do not have any comorbidities they may make you either prove you were on an at least a 6 month medically documented or 6 months of Weight watcher Jenny Craig etc. With BCBS Fed my BMI was over 40 and I had comorbidities so I sailed thru. I was banded Yesterday. Abkin and Bertha have a team that does nothing but gang up on the insurance companies and know how to get you approved. Good Luck:thumbup:

I have Horizon BCBS of New Jersey I had to do 6 months of dieting and now waiting for insurance co. approval . The Dr. told me that they go by your starting weight not your weight after the 6 months of dieting . He said even if I lost 30 lbs. and was no longer morbidly obese I would still get the band and be 30 lbs ahead .

I have the same ins company but I live in FL. Was it fairly easy to get your acceptance letter from Horizon BCBSNJ? Or did they make you jump through a bunch of hoops?

Thanks,

Gina

I have BCBS of NJ and started a 6 month supervised diet before selecting my surgeon just to be safe. I went to 3 different seminars before I found a surgeon that I was comfortable with so by the time that finally happend I was mostly done with my 6 months. I had my first consultation with Dr Bertha on 10/17 and was banded on 11/6 so it all moved very quickly. I had all of my lap work, nutritionist and psych consult done before hand so I didnt have to wait any longer. I would use the last month or so of the 6 months to get everything else together so that ones you get into your surgeons office you will be all set and not have any further delays. I acutally got my approval from the insurance company in less then a weeks time so that was very shocking after having read all the horror stories on here.

good luck on your journey

It took about one month for BCBSNJ to approve . They didn't give me a hard time or anything .

I had cigna then switched to Anthem BCBS/Ca, Jan 1st 2008. They have driven me crazy! I did my 6 months (more actually) prior to getting BCBS. I called them before I went to my first apt., they told me the surgery was covered, and in fact, they would never question a doctor's request for surgery - whatever! I have since phoned three times to ask the policy specific to bariatric surgery, I got the same response, just "doctor's orders." Stupid me, I'm thinking maybe this co. is different from my last insurance. I went ahead with all the pre-op apts., cardiac check, upper GI, sleep study, nut. apts, psych eval, the works. Guess what? I was turned down flat. I was (am) in the same boat as you, pre-diabetic, just below 40BMI, high bp, depression, family history, high chol/tri, the works. They refused me because I am not on death's door yet. I was told if I was taking 2 bp pills instead of just one, I could be approved! It seems there is nothing consistant in the info given to their clients. It depends where you are and who answers the phone at that time. If I was 40bmi or above, the same. But I'd lost weight with the 8 months I've dieted. I'm still 38bmi. I have read their actually policy through a thread from this site (bcbs wouldn't ever specifically tell me their policy). I guess I just have to wait until I'm fully diebetic, or whatever else might satisfy them. It just makes no sense at all. They paid for all the pre-op visits, surely this is preventative treatment. Anyway, I have filed an appeal - which they will not verify they have received! I've called emailed 5 times to ask for verification. I will probably file another appeal just in case they say they didn't receive my first one within 30 days! I guess I'm ranting because I'm just so down about the whole effort. Wish everyone else better luck. There are positive stories out there.

BC/BS Fed, must be different than Horizon BC/BS because in Jan they told me all I needed was a PCP referall, psych and nutritional eval, then in Feb said I needed a six month supervised WLP. My doctor is DR Bertha. I had a BMI of 43.5 with high BP, High cholesterol, hight trigliserides, sleep apnea, sugar, ETC. The insurance people said no exceptions, and Dr Bertha's people said I just have to wait.

MEM123,

Did you get anywhere with your appeal? Finally after 4 MONTHS I have been DENIED. Can you believe it took that long to get an answer on whether or not I was even approved? And that was after my 6 month diet. I am starting the appeal process now. I found on their website a 19 page appeal process that goes to Level 5 and then it's Federal Court. I cannot believe insurance companies decide whether or not we can get help or not. I am so frustrated I could scream.

Niecey

Neicey,

yes I did get approved. I had surgery 7/14. I was denied surgery the first time and like you, it took a while to get that denial. Then I appealed. Basically I sent a letter through their online site telling them how I complied with their rules, which were not specifically clear to me. I actually sent two online claims I think. Also, my surgeons office appealed the denial immediately it was received, I am sure that is what did it. After about a month I got a call from the Dr.'s office telling me that I had been approved.

If you really want the surgery and think you should be approved go ahead and appeal their decision, ask your Dr. (pcp or surgeon) to appeal on your behalf also. Make sure you are appealing to the right location. e.g., I am in TN where my claims are processed, but my insurance's head office for disputes is in Ca., I actually have BCBS of Ca., for some reason. My pcp told me to send my letter registered mail to the dispute location as they seem to take it more seriously, that's what she has noticed. I didn't though, just online as I said. Good Luck:cool2:

I am glad for you. Good luck. My DH's HR person has now got involved and now they are saying I need 12 months of "supervised" weight loss program with emphasis on the last 6 months. 12 months was never mentioned until now. I go back to my PCP tomorrow so they can write another letter appealing this. This is just crazy.

Neicey

Hi, i have bcbs nj and everything was submitted on 7-6 how long did you have to wait before hearing from them??

Thanks

chacha

I think it was about one month. Although, I called them to see what was happening and was told the surgery had been denied over the phone. The letter to me from BCBS took a couple more weeks. By then my Dr. had already filed an appeal. My BMI was between (37-35) over the six months or more I was meeting with my PCP; but I had other co-morbidities. Call them if you want an update, I did regularly! They may have got fed-up with me and just said no to annoy me! I have read on here though that some people get a reply within days. My surgeons's office say 4-6weeks though. Good luck!

Niecey

OMG! I though I would go crazy with the seemingly endless changing rules! I know exactly what you mean. You do the diet - then they want more. You have the co-morbids - that's not enough. When I finally thought I had it they said I had to be on TWO blood pressure pills, not one! I thought BCBS would give me a stroke before the surgery!!! I am so sorry they put you through this - but they have to keep their money (our money we've paid for years) as long as possible!