Good Morning Everyone:

This is my first post. I am anxiously awaiting approval from my insurance company, Horizon Blue Cross Blue Shield of New Jersey. Has anyone had any experience with them? They received my information on September 24th and I have been calling every week to check if I am approved. They tell me it is still in review. They say it takes up to 30 business day from receipt of the claim. I am getting nervous that I won't be approved. I have a BMI of 38 with no comorbidities, but I do have a long history of obesity. I would love to hear from anyone who has this insurance.

Annie

Good morning Annie,

I don't have your insurance plan. I have United Healthcare (NY State plan) and Blue Cross for the hospital portion of my plan.

However I waited over three weeks for an answer from my insurance and I can certainly relate to your feelings of anxiety while waiting. One day you feel sure they will say yes and the next day you are sure they will say no.

My BMI was around 37......and I have type II diabetes, thyroid disease, high cholesterol and blood pressure (controlled with meds) etc.

I went through all the tests and I guess the good news is that my heart is healthy and the only other thing they found was that I have GERD. I also gave them proof of 20 years of diet plans including Atkins, Weight Watchers, Nutri System etc.

Even so, insurance turned me down. My surgery date was cancelled. (August)

They said my BMI was not high enough and my co-morbidities were not severe enough.

Needless to say I was devastated! I didn't post here for over a month because I just felt so defeated and I just couldn't read everyone else's success stories while I was sitting here with feeling like I was stuck being fat forever.

My doctor's office appealed the decision and just a couple of days ago I got the approval.

I tell you this just to let you know that insurance companies sometimes turn you down the first time around......but if you are willing to fight hard enough (or if you have an excellent doctor and staff to fight for you) then you WILL get approval.

I do hope your plan says yes.........but keep the faith and keep fighting if they say no.

Good luck!!

I have BCBS of NJ. I do not want to give you bad news but you will have a hard time getting approved. My BMI was 40 (40 was the magic number for my plan) and I had no comorbidities at first. They then had me do a 6 month approved diet. It took me one year to be approved and during that year I become diabetic so that may have been the thing to finally push it over the edge. I'm sorry to say it was very tough. Maybe though this surgery is becoming more widely excepted and proven and maybe things will be easier than what I went through.

Good luck and let me know if you have any questions.

Niecey

Edited October 18, 200817 yr by Niecey

My surgeon's office did have me do the 6 month diet program before they submitted the information to insurance, so I am hoping that this will be sufficient. When I first called the insurance company to see if they covered lap band surgery, they didn't even mention the 6 month diet. They said they just needed proof that the surgery was medically necessary. I was a little annoyed that the surgeon's office made me do the 6 month diet, but I guess they know what the insurance companies are looking for. So I am still hopefull that I will be approved my first go around.

Thank you for your replies.

I have Horizon BCBS of NJ and had no problems with my approval. I did do the 6 month diet before I even met with my surgeon. I had heard that the insurance required it when I attended another surgeons seminar and figured why not get it done while I am still in the research process. I got my approval from the insurance in about 1 week which was a shock to me

good luck

I actually switched from BCBSNJ to Oxford because they would NOT cover my surgery with the particular plan I had. The insurance coordinator at my surgical center suggested them to me. I just hope they cover enough (Oxford) so that I can afford it.

I still have not been approved. I called the insurance company on Monday and they said my claim was still in review. I said that I thought all claims had to be reviewed within 30 days. The lady said she would put a note on the claim to have it expedited, which means they have to review it within 72 hours, so hopefully I will know by Thursday or Friday. I can't believe how long this is taking. I really want to have the surgery by the end of the year. I am tentatively scheduled for December 1st.

Anx Awaiting,

How long has it been since they received it? Only counting Mon-Friday?

Niecey

FINALLY APPROVED!!!!!!! My paperwork was recieved by the insurance company on September 24, 2008. I have been bugging them almost every day. They told me it was on expedited reiview several times, I asked to speak to a supervisor, was told that he would call me within 48 hours... nothing. I was getting very upset. Received a phone call today and said I was approved!!! They are putting a letter in the mail today to me and my surgeon. I am tentatively scheduled for December 1st, so hopefully all goes well. I am so excited and scared at the same time. I haven't told anyone - except my husband, so now I am getting nervous with the holdiays coming, but I can blow it off, and just spend more time mingling and playing with the kids.

Edited November 16, 200817 yr by Anxiously Awaiting

Congrats!!!!

Congratulations!!

My insurance initially denied me but they finally gave approval after an appeal......I have too many work related things to take care of right now so I can't think about surgery till January......problem is trying to stick to healthy, low carb eating in the meanwhile. I guess I won't really get serious until I have a definite surgery date.......good luck to you!!

Yaaayyyy! Congrats. I'm very happy for you. Keep in touch and let me know how you are doing. Dec 1 is good because that will give you time to recoup before Xmas. I'm so glad you got approved.

Niecey

I am so excited for you!!!!!! :cool:

Thank you so much for your kind responses!!

Congratulations! I'm submitting to the Horizon BCBC approval process in January, and I hope I get approved also! I've been on a 6 month program and have gained weight, which makes me nervous - but my BMI is 49 and I have PCOS. I just keep praying that I get approved.

My paperwork was sent in and in 5 days I was rejected by bcbsnj - they said i only went to five weight loss meetings when my drs notes and letter clearly says six.

I'm hearing they are now going to ask for a consult with medical weight loss dr/nutritionist plus six visits. Something is changing. I've emailed my surgeon to please appeal for me. Did everything else timely - even have medical release done, etc. Anybody hear anything about this? Thanks.