Warning Horizon BCBS

Hi everyone. I was scheduled to have surgery on Monday June 21st. Well that is no longer happening because BCBS has decided to stop covering the long limb bypass and will only cover the short limb bypass. Fine you say, just change the procedure code. It sounds easy, but BCBS keeps saying they didn't receive the additional info they requested even though it has been faxed 3 times. Then they say they have 45 days from the day they get the info to complete my predetermination. They have been completing my predetermination since April! I have never heard about anyone having a problem with Horizon, but myself and another patient of my surgeons have gotten our surgeries cancelled because of this mess. If you have Horizon please call them frequently. They are definately up to something! I hope everyone has better luck than me. Heather Hendrix

Ok, I am a little worried. My surgery is scheduled for July 6th and I have BC/BS NJ Plus. Two questions. 1.) is there a difference in the insurance carriers and 2.) What is the difference between "long limb" and "short limb" I have never heard those sayings before. Keep the faith and keep fighting... I will pray for you. Thanks

Your coverage under Horizon varies by "plan" and your employer's contract with them. Two people with "NJ Plus" could have different coverage. I hated dealing with Horizon. I called to check on the status of my request for surgery and they actually told me that I needed to have the doctor's office call; they don't talk to the insureds! W.T.F. Luckily it's all over and they covered me. Good luck to both of you.

Call BCBS every day if you have to. Make sure they complete your predetermination. Apparently you NEED a predetermination of benefits in order to get the procedure paid for. It is not an absolute gaurantee, but it is as close as BCBS will give you. My problem was that the insurance woman at my surgeons office said that all I needed was a precertification. WRONG. Precertification is only for the hospital stay not the actual surgery. Unfortunately, I stopped call BCBS when I was told I was approved because I had a precert. I found out my approval was still in limbo on Wed. I called and spoke to every supervisor I could. Then on Thursday I was on the phone with BCBS for an hour. I really thought I had gotten no where. Well lo and behold I got a call around 2:30 today from one of the supervisors I spoke to on Wed saying that he wanted to let me know that I was approved. He said my approval was so new that it wasn't in the system yet. Apparently he was sent my approval directly. He said he knew I was having surgery on Monday and wanted to make sure I knew that I had the approval. I was floored to say the least! Anyways, by the time he faxed my approval to my surgeon the schedulers at the hospital had left for the day. My surgeon was willing to make some calls and get me back on for Monday, but I said Thursday would be fine with me (he only operates on Monday and Thursday). So I will have lap RNY on June 24! I guess the squeaky wheel really does get the grease. Best wishes , Heather

Hi. I'm brand new to this message board and have been considering the Gastric Bypass surgery. Besides my concerns for my physical health, I was also concerned about the coverage of BCBS/Horizon. My son has Crohn's Disease and you would not BELIEVE the literal war we have had to go through with them to get them to cover stuff. Same thing with my daughter who had a heart condition. So, this news of how Horizon is handling everyone's pre-auths and approvals is nothing new to me. I knew it would be a rocky road. I've been wanting to call my insurance to find out exactly what my benefits are regarding this surgery, but I also don't want to give them the "heads up" until I have made my final decision. I know it may seem paranoid, but once you've been through it you understand. I don't want them waiting for me to ask for approval and already have the denial letter prepared waiting for a date. Does anyone out there work for Conectiv or have benefits through Conectiv? Think I should go ahead and find out the benefits? Thanks, Jeni

Good thing your doing it now, in Florida they will no longer cober after 1/2005! And at least one other state i heard. congrad on your approval! Joyce

Wow Heather, I'm sorry to hear about your problems with them. I have BCBS NJ Plus and had NO problems what-so-ever. They did try to stick me with half of the anesthesia bill because they said the surgeon never called ahead to say that IT WAS GOING TO BE DONE IN THE HOSPITAL. I mean....where did they think I was going to have it done? In the car on the way there? Anyhow, after a review, they took care of all of it. Good luck to you. Debbie