BCBSNJ (horizon direct access) how long for approval

[daco525 0]

I am wondering how long it takes to hear from the insurance company after everything has been submitted. My doctors office will have everything May 1st. Hopefully they will submit it right away. I am concerned because my employer is talking about making changes to our healthy ins by July. I don't know if I will have an exclusion. The surgeons office said they deal with all different insurance companies and they said that BCBS NJ-PPO does not reply before 6-8 weeks. Has anyone had a different experience. I was hoping to hear back in 2-4 weeks so I could definitely have the surgery before July. I really think I meet all the standards for approval and it is cut and dry but they said this does not matter. I should not expect to hear before 6-8 weeks. If I get an approval in 8 weeks I hope the surgery can be done immediately. I don't want to go through all this process only to find out my ins has changed and I have an exclusion. Of course this may not happen I am presenting the worst scenario but it is a possibility. :blushing:

[texasweb 0]

I am wondering how long it takes to hear from the insurance company after everything has been submitted. My doctors office will have everything May 1st. Hopefully they will submit it right away. I am concerned because my employer is talking about making changes to our healthy ins by July. I don't know if I will have an exclusion. The surgeons office said they deal with all different insurance companies and they said that BCBS NJ-PPO does not reply before 6-8 weeks. Has anyone had a different experience. I was hoping to hear back in 2-4 weeks so I could definitely have the surgery before July. I really think I meet all the standards for approval and it is cut and dry but they said this does not matter. I should not expect to hear before 6-8 weeks. If I get an approval in 8 weeks I hope the surgery can be done immediately. I don't want to go through all this process only to find out my ins has changed and I have an exclusion. Of course this may not happen I am presenting the worst scenario but it is a possibility. :blushing:

If BCBS NJ knows that your company is dropping their contract, then you will not get approval in time to have the surgery before the insurance is dropped. Do you know who they may change to?

[wannabthinagain 0]

we have BCBS Federal employee, so i don't know if that will make a difference, but I went for my consult last week on WEd. and i just got a call from the Dr. office letting me know i was approved (i had a lower than 40 BMI too) and to let me know what dates they have open for surgery! THAT was QUICK!!

i hope you don't have problems and they approve you quick!

[daco525 0]

Here is the story. I currently have BCBS NJ (Horizon PPO Direct Access). I had the option from my employer to choose this or the traditional plan. I am told that in July all employees will be on Horizon and there will be no traditional plan. I guess I should not be overly concerned since I never had the traditional plan, but I do fear that with the change they could put an exclusion for weight loss surgery when we all move to Horizon. I have not heard that this is fact, but I figure it is possible. This would be my worst nightmare after completing everything May 1st. I was hoping that I could have an approval and the surgery done before July. Does anyone have BCBS Horizon with an exclusion for weight loss surgery. I don't know if this is even common.

[breesband 0]

Hello everybody, i have BCBS of NJ PPO and my surgon office had told me that it takes very long for the them to approve i sent my paper work to the surgon they are sending it in on Tuesday to HBCBS. does anyone else have PPO and how long was the approval? they wanted to sched. me for May1st should u have it by than??

[daco525 0]

I too have this insurance. I plan on bringing everything to the surgeons office May 1st. I will be done with my 6 month weigh ins at that time. I spoke with the surgeons office and they told me that this insurance takes a long time for an approval. They told me to expect a 6-8 week wait. I think if you are approved and ready to go May 1st. that would be great. Please let me know how long it takes you to get an approval. I feel like you are one step ahead of me so I am interested in seeing how the process goes. Best of luck.

[seppi 0]

I have Horizon BC BS NJ PPO. I was approved in 2 days for the original band, 5 days for the removal and 2 days for the replacement. There was no a waiting period. We have no weight loss surgery exclusions. With the original submission, my doctors office had everything all ready...the psych, the nutritionist and medical letter from my regular doctor. Absolutely no problems at all.

Good luck.

[daco525 0]

I am so glad to hear that. I too will have everything ready. I even have two additional letters from a gastroentrologist and a podiatrist supporting the procedure for medical reasons. I know I meet the criteria for an approval so I hope I am as lucky as you and it happens quickly. My last weigh in with the primary is May 1st. I already scheduled the day off from work. I am taking the letter, office notes, etc and heading straight from his office to the surgeons office. I have worked hard for this and I feel like I am close.

[seppi 0]

I hope everything goes fst and easy for you. Good luck.