I GOT DENIED!! - HORIZON NJ/BCBS

I got denied from Horizon NJ for not having done the "required" 6 month medically supervised diet!! R U KIDDING ME!! I have called them numerous times since July and specifically asked them if I needed to do this and they told me NO!!! Now I might have to do this damn diet for 6 months and not have the surgery till the Spring when I could've been on the diet for 2 months alredy!!!! And when I asked the Horizon Supervisor that I was talking w/ this morning, if I loose this weight and my BMI goes down, there's a chance I can get denied once again? And she told me YES!!! My surgeon's AA gave my chart over to him to see what he can do! So hopefully there is a small miracle out there for me! I'm soo stressed out right now, I can't stand it!!

Unfortunately, many insurance carriers have this requirement. I had to go through the same thing with my carrier before I could get approval. Although the representative misinformed you, you should check to see if there is a Summary Plan Description Booklet (your employer or insurance carrier should have this info) to see exactly how weight loss surgery is covered and what the requirements will be. If it is in writing that you have to complete the supervise diet for six months, then there isn't going to be much you can do, but the six month diet. Good Luck, Carla

I am surprised. I have BC/BS horizen and they did not require it. Other co workers have also had surgery in the past couple of months and neither did they.....what plan do you have?

I have Horizon NJ PPO.. I have the policy and it's been in place since 6/22/01.. that's why i'm soo pissed cause when i called i was never told this!

I'm really sorry you've had to go through this. My insurance company said they required it as well, but the doctor was able to submit my paperwork with diets I had been on and it got approved. I hope the miracle is out there for you!

I am sorry Eileen, I know being denied is a big hassle and hard to deal with. I think sometimes it just depends on who opens the envelope at BCBS as to what your outcome is. Hang in there, do what they want you to do, but don't do it too well, lest you jeopardize your BMI going to low.... Michelle

See here's my dilema now.. do I do the diet "half-ass" and try to not lose too much weight and have the surgery, do the diet, and lose too much and risk getting denied, or do the diet on my own, lose the weight and NOT have the surgery?

Hi Eileen! I have Horizon BCBS POS and I was approved after the psych and nutrition evaluation! No supervised diet, no other consults needed....did your doctor put the paperwork in? It seems silly that you would have to go through this with BCBS. I work in a school and some of us have traditional, POS and PPS...I think all plans are covered for this. I would check again and speak to the supervisor. something sounds fishy!

im going to have this same problem as you. I have yet to go to my pcp to get things started but i know bc/bc that i have requires the 6 months of dieting. I to think of the"do i diet half ass" go to the gym to prove im trying then go to wendys right after lol to keep me from getting denied. My mother had the surgery and actually put on 20 or so lbs to get approved. I have the same questions you do and i think if you really feal that even if you diet later on your just going to eat your way back to the way you were before i would say try and put on like 10 lbs then do the diet with your doctor and actually loose some weight like 15 over the 6 months... should get you approved.

i have horizon blue cross and blue shield too and i did not have to have a 6 mos supervised diet..it may depend on what level of horizon blue cross and blue shield your employer subscribes too..that may be it...every reply i've read about horizon bcbs of nj noone had to have the 6 mos supervised diet..i was also approved in less than 2 weeks after my initial consult