BCBS/Horizion question??

Hi everyone, I wondered if anyone has BCBS/Horizion? If so, any comments about them and WLS? Thanks for any help! love, linda

Hi Linda! I have Horizon BC/BS NJ as my secondary insurance. When I was first denied by Aetna (my primary), I filed an appeal. Right before my second-level appeal I learned that my secondary insurance would cover WLS 100%. In the end, Aetna overturned my denial and ended up paying. However, I can tell you that Horizon BC/BS does indeed cover this procedure (and is covering it in 2005). I hope this helps! If I can help with anything else, please e-mail me! Hugs, Christine 245/210/150

hi linda, i have horizion bcbs of new jersey and i had my surgery in july of 2004 and i was totally covered. i also did not have to deal with them at all. my surgeons office did all the paper work for me. good luck on your journey. sherry

I have Horizon BC/BS and had absolutely no problem. They approved very quickly and I didn't have to do a thing. (of course I had an absolutely fantastic surgical coordinator in my surgeon's office and that is almost as important as the surgeon!!) Good luck and hugs, Kathy -51.5 lbs "I saw an angel in the marble and carved till I set him free" - Michelangelo

HI there, I have BCBS/HORIZON NJ PLUS. I called the insurance company, gave them a list of the "types" of Dr's that I was required to see for my surgery and they gave me a list of all the Dr's that I could use and that was covered by my plan. I never asked for permission or asked if the surgery was covered. I saw all the Dr's on my list , submitted it to the Surgeon and then schedueled my date. It was that easy, and all of it was covered. Best Wishes for you! Candie

Hey everyone, Thank you for replying to my post. I currently have Aetna/USHC which does not cover WLS. In April I will be switching to BCBS and have my fingers crossed everything will go well with them. I haven't received my benefits package yet. So can you tell me what the requirements are regarding dieting etc.? Also, can you recommend any surgeons in NJ which participate in the BCBS program? Thanks again for all your help! love, linda

Horizon BCBS covered mine 100%. They approved me based on the drs. questionnaire whi*****luded a diet history, but I didn't have to document it. All I needed was my regular drs. approval, the psych eval, and visits to the nutritionist & physical therapy dept. Once all that was done I was given immediate approval. My surgery was with Dr. Kamelgard, but he left UMDNJ and is no longer taking insurance. The dr. *****placed him at UMDNJ does take it. You might want to check with her, Dr. Bale. Also, there's a new program at Jersey City Medical Center and they take it from what I'm told.