BCBS-NJ

Pooh

After reading your reply today.  I thought I would call myself to the insurance.  

Typical call at the begining...  No information but she placed me on hold to check.  When she came back online she said that my request had been sent to the final department to review on 4/20/2009 and stated that there was no other info at this point.  She took my work phone # and my home phone that she would keep digging to see if she could get me some type of answer today.  I also called the surgeons office and the lady that takes care of the insurance was out on lunch.  I left a message and hopefully will know something today.  

I don't know what the process is at BCBS-NJ but if I made it to the "final department" it can't be all that bad of news.  I will let you know if I hear anything.

 

 

 

That's exactly what happened to me yesterday.    It's amazing that 8 weeks is the "magic" number then all of a sudden they try to be helpful.  I'm keeping my fingers crossed!

Well I am not holding my breathe

They told me yesterday that they would call me back yesterday.... 24 hours later I still have not heard from them.  Surgeons office has not heard anything.

I don't understand the comment about my paperwork going to the "final department"... I guess I should be happy that it has not been denied before the "final department"... I wonder what happens at the "final department".

Good Luck I have my fingers crossed for you

 

I'm not sure about the final department either.  Maybe it's like the "The Wizard of Oz" man behind the curtain and he decides yes or no.          Your wish is granted!



I bet they won't call you back.  You'll get a letter in the mail.    Snail mail will add another five business days of waiting! 

Positive thoughts, positive thoughts.

Postive thoughts

I didn't think about it that way as far as sending a letter instead.   Hopefully we will here something this week.  I will wait until Thursday again to call if not.  I don't understand why I haven't heard from the surgeons office yet.  They usually call right back.  I will try them again on Tuesday.

I think we are real close on days awaiting ... Monday (Today)  marks the 45th business day since they received (if I counted right... I also took out a day for Easter)
 
Good Luck hopefully this is our week

 

Specifically, I was told that they would send the decision "in writing" to my surgeon's office and to me. 

Hopefully, they'll fax the surgeon's office but I can't be sure.  After reading some of the other posts on this board, I expect a letter to come in the mail.  I'm calling again in a few days.   Nine weeks is ridiculous.

I agree....

When I arrived home last night I had some mail from BCBS and I was like oh-oh it turned out it was only a statement so the waiting continues.  You know how upset I am going to be if it turns out denied due to missing or incomplete information.   9 weeks of stress for nothing.   That would be my luck though.  

Well

I called today again into the insurance company and was told that they had made there desicion yesterday.   I was denied due to they thought this was not medically needed based on the fact I had not been through a 6 month supervised diet.  Why it took them 10 weeks to make that decision I don't know... 

Anyway I then called the surgeons office and asked if this Diet would be supervised through them or my PCP and they said it would be better through the PCP although they do have a non surgical weight loss program but the insurance does not pay.   For the most part my PCP does not want to be a part of this. So I guess I will be looking for another answer.

I hope you all have better luck and it comes soon.

 

Sorry you got bad news.  Don't give up.  The 6 month diet isn't so bad and goes by quickly but it's definitely a requirement for BCBS of NJ.  I did mine through the Weight Management Program at my surgeon's clinic. I did pay for it on my own.  It was about $600 total cost for the six monthly classes and weigh in check.  Overall, I thought it was beneficial as they write up everything and send it to the surgeon's office to include in your file.   Call and sign up for it so you can start asap. 

When I first started my process last July, my PCP wasn't completely supportive either.  I chose another doctor to monitor my diet progress and he was wonderful.  He wrote all the necessary letters, chart notes, etc . . .  Find a doctor that will support your decision.

Do you have a copy of the BCBS policy manual ?  In not, here's the link:

https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf

Click the SEARCH box on the right and type in Surgery for Morbid Obesity.   It outlines, step by step, what the requirements are to get approval.  Print it and keep a copy handy.  I also gave a copy to the insurance coordinator at my surgeon's office so she would know what they required. 

Good luck!

Sharon   

Pooh

Have you heard anything as of yet? 

I finally got my letter in the mail yesterday.   It looks like if I do the 6 months then they will approve. 

What kind of classes did you do during your 6 months.  I am attending a informational meeting next week with the surgical group as far as the classes they offer.  They would not get into much detail over the phone. 

Hope you got good news

Bob