Horizon BCBS HMO

Oh yeah, I meant I am going to Dr. Bertha too!  So far, I am very impressed!

Thanks for the input and support!

They are really great!  I just want to say, and please don't take this the wrong way, but you will not be able to get a fill until 90 days AFTER your surgery.  That was super frustrating and it is a BCBS thing.  They won't pay for it until then.  

Not sure if they told you that, and it takes a good couple of weeks to get on the schedule for a fill.  Last I heard they were going to start doing them in-office instead of the hospital, but just so you know.  

Thanks for that info!  And no, they didn't tell me that, but I have a question for you then........... if you know???

When you first have the band put on, before any fills............ it does make a smaller pouch out of your stomach, right?  Meaning, even though it is not filled, people still start loosing weight right?

Sorry, I'm still in the learning process.

It *technically* makes a smaller pouch.  I really didn't lost that much weight with the band (and had it out due to serious reflux issues), so I am probably not the best person to ask about that.  I just remember those first 90 days being tough and being pissed that I couldn't get a fill.

I am always surprised to see this question.. you would thnk by now every surgeon would know of the 6 month medically supervised diet requirement BCBS enforces.. and other if they aren't will as reform gets closer.
Even our member know this to be fact.
astounding..

I don't know if I explained myself in my original post, but I was approved to have surgery with the same insurance WITH NO 6 MONTH WAIT.  I consulted with a surgeon and then because of multiple reasons I decided to look into a different surgeon.  One of the reasons was because I got a call that I was approved about 5 weeks after my 1st consult, and then the surgeon scheduled me for the next week.  This was after the Psych & nutritional eval and he said that it was not a problem that I did not have the tests done that he originally ordered (endoscopy, pulmonary clearance and cardiac clearance) and that was all after obviously I did not have the 6 month wait, so either he lied to the insurance company, or my insurance really does not require it.

Anyway......... I am now using a different Dr. and have to start all over, so that is why I decided to post the question......

right.. I am amazed at the original dr.. not you..
Good luck with Bertha.. they were my first choice till they messed up my insurance and wouldn't help me straighten it out.. I hear they have gotten better..

Hi,
I have horizon BCBS ppo...I started the process in May...met Dr. Bertha..did the NUT and Psych the same day with Kingsley....did 4 out of the 6 month visits to the PPO...also went and met Dr. Garrison because I knew that the Band wasn't for me and I was hoping that either or both would do the VSG.

I went back to have a heart ot heart with Dr. Bertha and asked if insurance would ever cover him doing a VSG.  He was great!  Said NO...insurance would not cover..and he said that he did believe that VSG would be considered the Gold standard in weight loss surgery within a few years..(he did offer to do the surgery for about 30K for 1 night at morristown memorial)

I chose to self pay and go to Mexicali and Dr. Aceves.  It was a wonderful experience and I wouldn't change a thing.  24 lbs and 10"!

best of luck!
K

There are so many rules and regulations - I think I recall that if you do this as an outpatient there was no six month supervised requirement. The room - I was in it for maybe nine hours - cost about $10,000 if I recall correctly.