Horizon BC/BS of NJ ??

Anyone have this insurance? Their website is so hard to navigate and/or find anything. Aetna is my primary, and BC/BS NJ is our secondary. Wondering if they cover gastric bypass surgery?

I have that. Had Oxford last year and switched in Jan just for the surgery, cause they are good with coverage of GB as long as it's documented to be medically necessary. I had approval for mine within 2 weeks of the Dr's office notifying them. My Dr is out of network, but they have still covered most of it. The biggest portion was the hospital stay, and the hospital I used was in network. I've recieved over $60,000 in submitted claims, and I'm only going to be responsible for about $4,000. Of course even with the same insurance, your plan might still have some subtle differences. Hope this helps. mgm (surgery 3/16/04 - down 38 so far)

Hi, I have Horizon BC/BS of NJ, and I called to ask about the weight loss surgeries. According to the person with whom I spoke, the gastric bypass surgery and the lap band surgery are both covered providing that it is "medically necessary" and that another condition exists in addition to morbid obesity (such as diabetes, sleep apnea, etc.). If you choose an in network physician and an in network hospital, the surgery should be covered completely, assuming you get approved (there is a lot of paperwork). If you get a referral from your primary care physician, the consult with the doctor should be covered as well. The only thing I'm going to have to pay for (so far) is a required visit with a nutritionist and a psychological evaluation, but I can try to sumbit those costs to Horizon for reimbursement. In terms of getting approved, I've heard that Horizon is much easier than Aetna, but I haven't had my consult with the doc yet (May 26th), so I don't know for sure! Good luck! Sue

I have this insurance....the NJ Plus plan. They do cover GB as long as its necessary. I had a history of High Blood Pressure. I also mentioned the many other ways I dieted over the years....the successes, the failures. They approved me rather quickly actually. My surgeon, hospital, and anesthesiology group were all in-network so, I'm pretty much paying my minute co-pay. I expected alot worse. BTW, my surgeon's office did most of the paperwork for me. God luck! Debbie

I have this insurance and was banded in March and I have only paid a total of $39.00.......my friend has the same & had by-pass in Feb and she hasn't paid anything so far. I called b/s-b/c in the beginning to just double ck and they told me they did cover both weight loss surgeries. I had the evalutations and dietician visits and all was submited through the surgeons office. All I did have to do was fill out a long form with alot of questions about my weight loss-gain history and the DRs office took it from there. It was a very easy process. Good Luck..........

Hey Christine, Both my husband and I had RNY open and we were approved by BC/BS NJ within 6 hours of the paperwork being processed. The only thing we paid was co-pays to see the surgeon. The problem you may run into is this - Aetna also approves this surgery (unless your work put in a special exclusion). However, where both BC/BS and Aetna state it's approved if medically necessary, Aetna requires 6 months to a year of doctor supervised diet and exercise (Weigh****chers does NOT count) - to date BC/BS does not require this, they just want a history of weight loss attempts. This means, if Aetna is your primary and they do cover it, you might get stuck having to use them, which can detain you, if you don't already have 6 to 12 months of monitored dieting/exercising. Good luck! Denise

I have Horizon BC/BS "PPO". You have to be careful because they have different plans, and employers have individual contracts with them within a plan grouping, so it's hard to say that they'll cover you. They did cover me. As far as I know there were no problems with my approval - I didn't have much to do with it except for the running around gathering info. Good luck, Jen

I have Horizon POS. My doc is not in the network for this particular BCBS but my insurance covered it, mostly. I have a 500 dollar deductible for OON then i am responsible for 30%, my hospital was covered 100%, thank goodness. I probably would have sold a kidney to get this done though, LOL. kelly -58

I have heard that Horizon BC/BS is good with approving surgery. I sure hope so! I have the PPO Blue card plan with Horizon. My paper work was received on April 20. I am currently waiting for my pre-determination to be completed. According to my Dr. Horizon is easy to deal with. Hopefully I'll be approved soon. Heather