Horizon BC/BS - 7 month weight history requirement???

Hello fellow NJ friends...

Everyone in my surgeon's office is waiting for official word from Horizon BC/BS about their 7 month weight loss history requirement.  Rumor has it that they are doing away with it, but they don't know what, if anything, they will replace it with.  An announcement was supposed to be made on June 19th, but still nothing.

Has anyone else heard of this?  Do you know if the announcement will be public - like on their home page?  I am so curious!  I'm hoping they are doing away with it, because apparently my last 7 months doing Weight Watchers online will not satisfy this requirement.  I really don't want to wait another 7 months!!!

Yeah, I am not sure about the WW online.  I have Horizon BC/BS too.

I went through the process starting in January 2008, got banded exactly 2 years ago today.  My 6 (not sure when it turned into 7 months) month weight loss was documented by a monthly visit to my PCP.    Did they tell you that 7 months of WW would be sufficient proof of weight loss?  Were you specifically rejected because of that?

Initially, I was banded 2 years ago (today, actually!) and had it removed in March 09, and revised to RNY in April 2009.  I did not have to go through the approval process again for the revision.  So in the past 2 years they may have changed it - but to 7 months seems odd.

Yes, that's what the paperwork says.  Month 1 begins on the last day of your first month, so technically it is 7 months.  Does that make sense??

I didn't get rejected...I am actually still gathering all my pre-op requirements.  When I told my surgeon I was doing WW online, he said "Great!  That counts as your weight loss requirement...all you need to do is bring us receipts saying that you paid."  Then I met with the surgical coordinator (she's the one who deals with all the insurance stuff) and she said that in the past Horizon has not accepted WW online at all.  

So basically, we're waiting to see what this announcement is from Horizon.  I have the WW credit card transactions from my bank statement, and my weekly weight log from the online program.  If Horizon doesn't change the requirement, I am really hoping that one or both of those will be sufficient.  I still have about 2 - 2 1/2 weeks before I'm done with the other requirements (nutritionist appointment, psych eval, etc.) before we submit for approval.

 Not really - I went to see my PCP in January and my last visit with him for the 6 months was about 10 days to two weeks before my surgery date.  I saw him once per month in January, Feb, March, April, May and June.  6 visits over six months.

Month one ENDS the last day of the first month, starting month two.  My first month was started January 15.  Feb 15 started month 2.  And so on.  

That's how I counted it, and so did Horizon and both my surgeon and PCP's office.

Not picking a fight, but I really had 6 visits over the course of 6 months, and was banded literally less than two weeks after that appointment.  The day after that appointment my doctor's office submitted my paperwork and I was approved the next day.

It was officially announced that the requirements are lowered to 2 months support group and NUT evail from the 6/7 month requirement.

This was announced at our support group.

I had RNY under HBCBS POS in Nov. 06 and was approved immediately, no out of pocket expenses required. I now have PPO but maybe things have changed. It could be your company's specific plan too.

Thanks, Val!  In that case, let's hope WW online counts as a "support group."

Jennifer - you made second guess myself so I called today to verify!  Apparently, it is really a 6 month requirement.  However, all my surgeon's paperwork says 7 months so people understand that they need 6 COMPLETE months of the program.  On the 1st day of the 7th month, they can submit.  Therefore, they indicate 7 months.

Confusing, I know.