Horizon Blue Cross Blue Shield of New Jersey

Hi There. I just started this process. I have decided I want to have the surgery.
I have Horizon BC BS of NJ, their enhanced PPO plan. I have contacted a surgeons office and I have attended a informational session about the surgery.
The Dr. office told me my isunrance pays 80%, I am responsible for 20% but it wouldn't be more than $1250.00
They didn't say anthing else.
Then I called the inusrance company. they said the Dr. office would have to submit a predetermination and i would have to complete a six month diet program that is documented like WW or Jenny Craig.
Also they said in addition to the 1250 they said I would have to pay the office co-pays and 500.00 co-pay per day for the hospital.

I was wondering if this is this normal. Anyone else have this plan?

Thanks

I have BCBS of Minnesota and I had to have a BMI greater than 44; 6 months Dr. regulated diet/exercise documentation. They also said that I had to go to a "Blue Center"--sorta like Center of Excellence.   I picked St. Luke's of Allentown, so I will be responsible for either 20 or 30%. 

I started my 6month thing last June.  Just went to my family Dr. every month and was weighed and blook pressure taken.  Went up and down on the pounds.  I Finished that in December.  Went to a introduction meeting in January .   I also had to do a psych eval, a nutrional visit and atend a support gropup.  I was just approved on April 12th to have surgery for May 25.

hamchs2 you are gonna love St Lukes and the team. Years ago they had a surgeon that wasn`t up to their standards but they got Holland and his team now so it`s great.

To the OP that sounds about right as to their requirements. St Lukes I believe is a Center of Excellence so for some insurers the prerequisites are shortened. Every employer tailors their policies to their needs. EX BC/BS of Northeast Pa not every PPO plan is the same or has the same deductibles.

Thanks for the info, I just submitted my paper work from my doctor of my notes for the past six months. Dr. dallal office will set me up with the rest. I am sooo hoping that I get approved.
Thanks again for replying!!

Good luck with your surgery, coming up!!!!

I also have BCBS of NJ and they paid for everything. At first they did not want to, but my surgeon called them and they agreed to pay for everything.

Sorry I'm so late to the game!

3 years ago I had bcbs nj ppo.  I paid some minimal copays with each dr. surgeon appointment I had prior to surgery.  And then I believe it was a $500 one time copay for the hospitalization, not for all three days I was there

Good luck!