BCBS of NJ questions.....help

I am feeling really sad right now. I was wondering if anyone out there had BCBS of NJ (PPO) I only have weight records from 2001, 2005, 2006 & 2007.  I went from having a BMI of 38 to now I am up to a BMI of 50.8.   My insurance contact at Barix clinics said everything else I have is good but I dont have enough weight records.  Has anyone else had this problem? I am boarderline diabetic, I have thyroid disease (which I didnt have until I get heavy and they cant seem to control it at all now) and clinically significant sleep apnea. Any help or thoughts would be great.  Thanks Vicki

Vicki, I too have BC/BS of NJ PPO. I have NEVER been seen by my PCP for my weight but the Ins. required only 6 months of documented records. My Dr. wrote a letter stating that he had been treating me for over a year. They never asked for any proof. See if your PCP will write a letter. You have records for a few years.  Best of Luck to you! Amy - Lap RNY 6/11/07 Surg/Now/Goal 254/219/135 84 lbs to goal

Amy,  I will have to talk to my Insurance person about that.  I hope it will work. I dont know what else to do. I feel so lost and helpless in this body.   My insurance specialist from Barix said I needed 5 years of weight history, a nutritional eval, and a psych eval. If you dont mind me asking where did you have your surgery?

Hi Vicki, Did your doc submit you paperwork yet??  Did you go for your psych eval or nut eval? Jackie

HI Jackie, My doc office didnt submit yet. I went for a sleep study (2) I went for a psych eval & I had my nutritional evel.   Paperwork is all in, but not looking good since I am missing so many years of weight history

Hi again, I have Horizon BCBS NJ HMO.  My paperwork was submitted today, I only had weights from 1/24/2004 - BMI 39.8, 9/2004, 3/2006 & present - I asked my doctors office and they didn't seem too concerned.   I am praying that I get approved.  Ask them if they can submit it like that.. Jackie

I called the insurance people at Barix and said for them to just go ahead and submit my paperwork. I cant get anymore.  I hope my insurance company approves me!!!

hi vicki my husband has horizon bc/bs of nj -- he had his surgery a year ago -- the only thing he needed at that time was a 3 month dr supervised diet -- he didn't have to submit years of proof of being overweight -- see if barix will submit what you have and take it from there -- we both did our psych evals at Penn Hosp in philly -- it was $200 and insurance did not cover it -- and we both did our nutritional meetings after approvals --  my husband had his approval in 2 weeks -- good luck to you :)  Roberta

I am hoping that they will accept what I have. Thank you all so much for your input, I dont know where else to turn for help and guidance and here in just 2 hours I have heard wonderful and helpful things! Did your husband have to appeal at all? I mean did they ask for something then say they needed something more. Does it make a difference that I have BCBS of NJ PPO  Direct Access?????

nope no delay at all -- approval on the1st shot -- our surgeon's office made sure they had everything before they submitted the packet of information -- we both had to fill out paperwork from the surgeons office detailing past diet attempts -- he had a 3 month dr supervised diet and i had a 6 month dr supervised diet -- psych eval -- letter from our PCP -- submit -- and we got our approvals in about 2 weeks -- and we have different insurance companies -- then after that we had our nutritional meeting, cardio clearance and pulmonary clearance -- they made sure we had our approval BEFORE we spent any more money than we had to -- and we didnt' get a surgery date until we had our approval and all our clearances -- so we weren't running around trying to do this and do that -- everything really flowed like clockwork -- and our surgeon is also a gastro/intestinal surgeon -- so if anything ever happens like Gallbladder or Hernia he can fix it without us trying to find a different surgeon -- especially another surgeon who will touch you AFTER wls -- not many surgeons will do anything on a person who has had WLS because of the different plumbing  so plan carefully :)  Roberta