Just got my letter, unable to make decision

tink929
on 3/21/15 8:38 am

Horizon BCBS New Jersey. Letter states, we are unable to make a decision at this time. Says they need additional documentation. I submitted everything, 6 months dr filled out weight form, nutrition eval, Psy eval, blood work, ekg, and chest X-ray. Not sure what else they need. Will need to call the surgeon Monday and Insurance company to see specifically what the problem is. 

Such a bummer, I was hoping for an April date, now I may not even get it approved....

 

Kathy S.
on 3/21/15 8:52 am - InTheBurbs, XX
RNY on 08/29/04 with

While this so unfair, take a breath and give them a call on Monday.  See what it is they are looking for and go from there. Surgeon's offices are great help in these matters as they have been through it before with other patients. Give us an update when you hear what is going on....

Hang in there

HW:330 - GW:150 - MW:118-125

RW:190 - CW:130

Tracy D.
on 3/23/15 3:49 am - Papillion, NE
VSG on 05/24/13

This happened to my husband too.  What his insurance company needed was more documentation on his co-morbidites (sleep study test results, high blood pressure DX info, etc.)  They probably just need some more healthy history information from your doctor. 

 Tracy  5'3"     HW: 235  SW: 218  CW: 132    M1: -22  M2: -13  M3: -12  M4: -9  M5: -8   M6: -10   M7: -4

 Goal reached in 7 months and 1 week

 Lower Body Lift w/Dr. Barnthouse 7-8-15

   

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

    

tink929
on 3/23/15 4:46 am

Thanks, I hope so.... still waiting for the surgeons office to return my call.... all this waiting is making my anxiety worse!!

ce_110571
on 3/23/15 5:47 am - San Jose, CA

Yes please let us know what they say. I too have Horizon BCBS New Jersey and recently finished the 6 month with my PCP and just starting the process of getting everything done with the surgeon.

tink929
on 3/23/15 6:03 am

This is so crazy, the surgeons office just called and said not to worry.  Basically this is a form letter they send out saying, yes thank you we received your request.  According to the surgeons office this is normal.  The "package of documentation" the surgeons office sent them has not been reviewed yet.  I feel a little better now knowing nothing was missing, but still discouraging.  It would have made more sense to actually say, thank you we received your request and will review your submitted documentation...

 

So if anyone gets the same confusing letter, they say not to worry and I still need to wait.  THe Horizon BC/BS of NJ website says it could take up to 30 days.  I think I will give them a week and if I don't hear anything call the insurance company.

 

Thanks for listening to me vent.... just so frustrating, I just want to hear if I am approved!

 

tink929
on 4/9/15 11:51 am

Finally got my approval!!!! Surgery date May 7. I really thought I would never get here.  The surgeons office sent everything March 16th. It seems my paperwork was stuck in limbo at the insurance company. They changed my status to nurse review, but no one actually sent it to a nurse to review. My surgeons office finally had them expedite the review and I had an answer the next day! 

Getting ready to start my pre op liquid diet Apr 23. I really can't wait! So happy to ginally have approval and an actual date!

 

tink

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