Horizon BCBS HMO

I'm wondering if anyone out there has any experience with Blue Cross Blue Shield HMO?  I have that insurance and my Dr.'s office is telling me that I have the 6 month wait.  When I called my insurance company, they told me that the requirements for being eligible for bariatric surgery is that I have a BMI of over 40, or 35 with "co-morbitities", and the psych eval, and the nutritional eval.

I was just wondering if anyone from NJ on this site has that insurance and had a Lap Band or other Bariatric Surgical Procedure and what the process was for them?

Thanks!

Yes, with Horizon BC/BS you have to be on a 6 month supervised diet.  It goes quickly since you are doing all of your other clearnaces during that time.

I just finished my 6 months last week.  I remember when I started it felt like a sentence....so far away.  But truthfully, the time flew by, and it was a good opportunity to learn about the lifestyle I am choosing, as well as interview a couple of surgeons.

Have you decided which surgery and which sugeon you prefer?

Good luck, and don't get frustrated.. 

Hi, and thanks for the info!  I was going to 1 surgeon and approved and everything (without the 6 month wait).  I was approved for a RNY gastric bypass and was all scheduled for surgery but decided that I wanted to go see another surgeon and get more info on banding.  I am assuming that the first surgeon sent in false records stating 6 months of the same weight?  Because I was already approved.  Once I started with the new surgeon who does Banding too (the 1st one really didn't do the band) it was almost like starting over because for insurance purposes, it was a whole different "pre-certification" because it was a different surgery and surgeon and facility.  So now it's almost an additional 3 months since the start of my "journey" with the 2nd surgeon.  With the first surgeon, one of the reasons i decided to change was that once he got the approval, he wanted to do the surgery and told me that it was not a problem that i didn't do any of the prerequisite tests he originally wanted me to do~~ like the endoscopy.  So I'm doing that now................... while i wait.  But in a way I'm glad because I found this new surgeon, Dr. Bertha, and the practice seems really great!  How did you find your surgeons?

I  don't know how the first surgeon got around the 6 month wait - did you provide him with records from your primary w/ weights recorded on the records? 

I chose Dr. Nusbaum after going to 3 different surgeon's  seminars.  I felt the most comfortable with Dr. Nusbaum's skills, reputation and experience.  I was also able to use his NUT for the 6 month medically supervised requirement at no cost, and I really appreciated that service.

I don't have that insurance, but...

My surgeon told me that my insurance company has a 6-month wait, but when I called the insurance company, they said they didn't have the wait period.  Benefits change, some employers have different options, so while the surgeon's office knows generalities, they might not always know your specific benefits unless they've dealt with your particular employer.

Just a thought.

I waited the 6 months anyway, as it turned out, it goes pretty fast...

Elizabeth

Your exactly right!  Every one's benefits are different.  Even though they have the same company and or plan..... each employer does have a lot of different options within the plans.  That is true.  I'm not going to Dr. Bertha too, and i guess that is really how their office prefers to do it. 

As far as the first Dr. I went to, I didn't provide him with any records but I had been the same weight for 6 months.  He probably fudged it in his letter to the insurance company.  That is probably what happened.

I guess I just have to be patient.  Its already 3 months anyway..................

Thanks for responding!

Well that's cool that you're going to Dr. Bertha too!  Good luck with the process.

Elizabeth

i have bcbs ppo and had to do the whole 6 month thing too

I have BCBS Horizon and when I had the band last year, had to do the 6 months, NUT & psych eval, along with letter from my PCP.

When I had my revision, everything was covered, and I didn't have to re-do anything.

Dr, Bertha is awesome!  You will love him!!