Warning: Horizon BCBS

Hi everyone. I was scheduled to have surgery on Monday June 21st. Well that is no longer happening because BCBS has decided to stop covering the long limb bypass and will only cover the short limb bypass. Fine you say, just change the procedure code. It sounds easy, but BCBS keeps saying they didn't receive the additional info they requested even though it has been faxed 3 times. Then they say they have 45 days from the day they get the info to complete my predetermination. They have been completing my predetermination since April! I have never heard about anyone having a problem with Horizon, but myself and another patient of my surgeons have gotten our surgeries cancelled because of this mess. If you have Horizon please call them frequently. They are definately up to something! I hope everyone has better luck than me. Heather Hendrix

Heather, I am so sorry about your surgery being cancelled. I HATE BCBS! They drug their feet with giving me an answer to my level one appeal so I was able to skip the level II appeal and go straight to the external appeal board (I'm still waiting for a decision from them and praying they overturn BCBS's denial). I really wish Congress would pass something saying that all WLS would HAVE to be covered (but, what are the chances right?). We should not have to go through the trauma that these insurance companies inflict upon us. I wish you the best and keep your chin up. Stay on top of BCBS and let them know you are not going away!

After they didn't get the first fax, you should have changed your delivery option. I tell all of my clients to NEVER FAX an insurance company!!! Every piece of correspondence should be sent FEDEX or UPS. That way you can track it, and you have proof of receipt. I would suggest that you resend your entire packet in this manner NOW. Good luck to you, Roberta