NJ Direct (Horizon)

I'm not having much luck with this website so far.  When signing up it required a surgeon's name but I don't have one yet.  I have an appointment with the surgeon I named but I haven't had the consult yet.

My BMI is @ 36.4 maybe a little higher.  I'm a female, by the way.  I have NJ Direct.  My comorbidities are: hypertension, asthma, stress incontinence, depression, osteoarthritis, and high cholesterol.  I had a sleep study done because I have insomnia.  I doubt that I have sleep apnea because I don't snore but who knows.  I'm still assuming I dont have it.

Are the comorbities I named enough for the insurance co to approve surgery?  Please help.  Any info you help is appreciated. 

Hi   I also have Horizon Direct, but my BMI was above 40 so I didn't have to worry about the comorbities issue. However, even if you have not picked a surgeon yet, I would talk with any office that you are currently thinking of using.  They are the best people to tell you whether your comorbities qualify.  My doc got a predetermination letter 7 months before my surgery.  So even if you use one doctor to find out if you qualify , you can always change docs once you make your mind up on who to use.

Even though your question is directed to NJ, you may want to post this question on the main board since there is more activity there.

Good Luck on your journey

Alex

First remember, EVERY PLAN is different. Each company purchases different options, so it's hard to say a definite YES .. however, your comorbities DOES help, especially since you have a "borderline" BMI (anything with a BMI of 35 w/comorbities helps - 40 you don't need one).

The one thing you really need to ask your insurance company is if there is any EXCLUSIONS on your policy. You want to hear NO !! If there are, then you need to find out what those exclusions are.

You should get approved with that info just go to the doctors listed that Dr wasser gives you for your pre-op testing. also complete your 6month diet.. I have nj direct and my surgeon is affilated with your surgeon..

I see I have several replies to my question.  I noticed this since I haven't checked back to this site for a while so thanks t everyone *****sponded.  And Ladysweetthang, can I come to the support group meetings now since I've already had my consult with Dr Wasser?  I would love to start that since I have a lot of questions and I'm also scared.  I originally wanted the lap band but now I believe the RNY is the better choice.  It's also major surgery and a lot my scary.  Any one have an opinion on lap band vs RNY?

there are 4 main types of surgery....  you've mentioned the RNY and the Lapband....  but you need to research the DS  (duodenal switch) and the VSG  (sleeve gastrectomy)....   they each have a forum here, so you can ask questions, read about peoples experiences, etc....   Pick the kind of surgery you think you can live FOREVER with...  then find the surgeon who is an expert in that type.   If you pick the surgeon first,  you're only going to hear about the types of surgery they offer,  not the type of surgery that may be best for you.   Each type has advantages and disadvantages....  it depends on what you can live with...and what your history was....  I could lose weight, and had,  many, many times....but always gained it back with some extra.  I knew I needed a type of surgery that had a lower percentage of re-gains....   some people want the restriction of a lap band....and don't want the constant blood monitoring and vitamin taking of a DS.   Keep researching....  ask a lot of questions...  and don't rush into anything....  Think twice,  cut once!!!!     (also,  read the Revision board under the surgery forum....  what types of surgery do people complain about the most????   who's looking for revisions after a year or two???  that might be an influencing factor!     Good Luck with your research!   Mary C

Of course you can go to the support group everyone is welcome..

edited to add also your lap vs rny question would be better asked on the main board