Horizon NJ - PPO

Is anyone else besides myself having the hardest time getting approved through them?  They denied me last Ocotober (that I didn't do the 6 month supervised visits w/ the Nutritionist). It's now June and I've been going since February and they just "denied" my April claim that I exceeded my limit!  One person there that I spoke w/ told me that I only had "3" vists that they'll pay for and the 2nd person that I spoke w/ 3 hours later and that person told me that my plan shows "1 course treatment".. I asked what that entails and she didn't know!  I now have my benefits people at work dealing w/ them to find out exactly what they are going to pay for!  This past year has been so stressful that I feel that I am never going to have this surgery!  I'm hoping that next month will be my last visit and that my surgeon (Dr. Meilahn) will submit me for surgery!  I JUST WANT TO HAVE MY SURGERY ALREADY AND GET ON WITH MY LIFE!

I have the same insurance.  I had NJ plus When I started.  Then in Jan. my company switched to POS.  My approval was easy.  I never did a six month supervised weight loss.  I just had to prove that I have been obese for over Five years.  You get three nutritionist visits in a year.  I did two. you should have been going to your primary doctor each month to be weightd in. 

 Keep your head up, if you want to talk more in detail send me a pm and I'll give you my number.

Eileen - I had posted a "heads up" a couple of weeks ago that all the BC/BS plans were being difficult about both WLS and post-op PS in the past 2 - 3 months. My plastic surgeon told me about problems he's had since doing my TT and BR/BL. (I had no problem but my PS was 7 mons ago). Despite having authorization for procedures they were being denied payment once the procedures were done and they were told to go after the patients for payment. My co-worker was approved for lap band on 5/30; 5/29 she got a call that they wanted more documentation. She was told the lap band procedure would be out of pocket if she kept the date. That was with NJ Plus which is an BC/BS HMO. Try to be persistent and document the names of everyone you speak with and try to get authorization codes when you can. Good luck. Wilma