BCBS of NJ - CAUTION!!!

NJChick · October 18, 2005

I know all policies are different but here's something to look out for... just incase.

Beware, if you need a predetermination # before your surgery, make sure your doctors office sends the information in at least 4 weeks b/4 surgery. There is a policy that they need a full 21 days before sending out an approval (bull kaka).

FOLLOW UP FOLLOW UP FOLLOW UP... call them a few times a week to make sure they got your records from the surgeon.

My surgery will probably be postponed a few weeks because neither my doctors office nor I knew about this "21 day" rule. WHO KNEW!!!!

I was / am scheduled for Monday October 24th.

I am just so besides myself right now that I could spit nails.

chichigirl · October 18, 2005

Oh Eileen,

I'm so very sorry that you may have a delay in getting your surgery. These dang insurance companies are so exasperating and I think they deliberately do this to discourage or postphone people to try and get out of paying for it. They're looking for loopholes to tie things up, but don't you dare give them the satisfaction of giving up. They are not worth it, you deserve to have this surgery and to have the insurance company pay for it.

I understand it's disappointing, deciding to have the surgery is difficult enough, so that when these stupid things happen just as we are cranking up to go through with it, bam, the insurance company, usually just days before, through in the monkey wrench. They are very clever at manipulating people and hitting them below the belt. They are unfair with the way they play the game and they couldn't care less about the people as long as their bottom line doesn't suffer.

You show them you are made of much stronger stuff than that and we already know you are smarter than they are. The same stupid thing happened to me and I remember the awful feelings, the crying, the fury and rage I went through. It wasn't pretty, but I didn't give up. I made them pay in the end, and that's all I cared about. By the way, it was BCBS of FL that did that do me, big surprise.

You are going to have this surgery and you are going to have it before Christmas and probably before Thanksgiving even. The insurance company had to scrape the bottom of the barrel to come up with this excuse, which is one that is easily resolved and you already have the wheels rolling on that. Just sit back and say to yourself, you will have the last word and they will lose this battle.

In the meantime, we are all here for you and feel your pain!

(((((((((HUGS)))))))))))

I'm here whenever you need me, I hope you know that. You are very special to me and will do whatever I can to help you through this.

More - ((((((((((((HUGS))))))))))))

Cindy

DeLarla · October 18, 2005

Sorry, we don't have any nails.

NJChick · October 19, 2005

Thanks Cindy, your the best.

Yesterday was a fog, today I am PO'd. Just imagine hearing the worst foul mouth with a jersey accent.... yeah, thadda be me. I really want to bite some one.

Lisa

Alexandra · October 19, 2005

Eileen, you may be frustrated but in the long run three weeks will not matter one tiny bit. Get a grip, take a deep breath, and relax. Horizon is very good about approving bariatric surgery, so you really have nothing to worry about. Every little frustration seems huge when we're waiting for such important developments, but it helps to have a little perspective.

Before you know it, you'll be prepping for surgery. Keep smiling!

NJChick · October 19, 2005

Thanks Alex. It just sucks to have to go thru all that testing again, ie, blood work, medical clearance, etc. Its timely and costly. Shoot, I've spent out of pocket already over $1200.00. My nerves are shot, you remember how it was.

I have my HR department investigating it. It seems like no one has heard of this "21 day policy."

HUGS

I don't know what I would do with out you all..... I MEAN IT !!

Alexandra · October 19, 2005

Thanks Alex. It just sucks to have to go thru all that testing again, ie, blood work, medical clearance, etc. Its timely and costly. Shoot, I've spent out of pocket already over $1200.00. My nerves are shot, you remember how it was.

You shouldn't have to do any of that again, really. Horizon may just be saying that they can't give a precert for any surgery faster than three weeks, because they need processing time. In my experience they send out approvals much faster than that, but they will always tell you there's a three-week lag.

Also, in most cases, carrier's approvals are only good for 30 days, so once you get the approval you can have surgery within that time frame.

NJChick · October 19, 2005

Yep, but the surgeons office said they couldn't do it until late november which means my blood work is not good b/c thats only good for 30 days.

Who knows, I might just skim by, hopefully

October 19, 2005

Serenity . . . serenity . . . let these companies do their worst, they're just trying to stall. You're going to have your WLS surgery, you're going to do well post-op, the excess weight is going to go, and you have all the time in the world to make it happen. So what if, worst comes to worst, you have to get "stuck" again for more bloodwork -- you know your goal, and there's not a thing they can do to make you drop that precious bundle you carry: your dream.

So go after it, girl. You are in the driver's seat -- all they can do is delay you with their childish antics. SERENITY -- who-the-hell-cares. You're going to get there, and in the end, YOU are all that matters. Focus on you, on your body, on what you're doing for your body, and how well you're going to do on this new journey you're about to undertake.

And if your insurance company manages to indeed get under your skin, you can always try my own particular favorite: that wonderfully adult attitute of "I CAN LAST LONGER THAN YOU CAN, NYAH-NYAH-NYAH!"

Love, KJ

Alexandra · October 19, 2005

NJCHick, my fingers are crossed for you.

Oh 2 Be Free · October 20, 2005

That really sucks... I wish the best for you my friend, truly. Don't give up.

Iluvharleys · October 20, 2005

I know you are upset, I would be too! Just remember "everything happens for a reason" even though we don't understand why. I am keeping my fingers crossed that it will come through before then though.

NJChick · October 20, 2005

Thank you everyone

My HR Department is on their ass. The are putting it thru a 48 hr expidited review (which my friend here at work who went thru the same crap told me to ask for...thank GOD for her) So I'm going to find out tomorrow, but in the mean time I still have to go to my doc for pre op stuff tomorrow morning. I'm going to call again today to see if they caved in LOL!!!

Your all right....... I feel like an ass.

Its just my nerves are kablooie

This too shall pass. LOOK AT MY SIGNATURE duh duh duh !!! lolol

LOVE YOU ALL !!!

NJChick · October 22, 2005

Key words to use with BCBS of NJ is

"An Expidited 48 Hour Review"

This is what you need to tell them incase they are trying to blow you off. They did this to another girl at work as well.

I'M APPROVED !!!!

As of 10 am yesterday....sigh

Surgery is Monday the 24th at 4 pm...whoohoo

GOD BE WITH ME !!!!!

THANKS EVERYONE !!! I hope this helps the next person.

Alexandra · October 22, 2005

All RIGHT EILEEN!!! Wow, now you barely have time to catch your breath before you'll be a bandster!

Have a great, calm weekend and try not to stress out. Monday is almost here! Best wishes for a totally safe and uneventful surgery and recovery. Check in soon! :D