hi everyone, i joined this site in hopes of finding information about weight loss surgery, and stumbled upon this thread, which is awesome. like the OP, i too live in nj and have horizon nj health (plan D, which is not AS great as Plan A). i called up tonight to see if i could have weight loss surgery under the plan i have, and the answer is yes. here are the requirements for the surgery under horizon nj health:
- you must have your primary care physician (PCP) agree that surgery is a good choice for you, and they must medically clear you for the surgery.
- you must have recorded at least one non surgical attempt at weightloss within the last 12 months (weigh****chers, jenny craig, lucille roberts, etc.).
- you must have a psychological exam and clearance pertaining to weightloss surgery (to make sure you understand what it is and the effects of it).
- you must be preauthorized for the surgery by Horizon NJ Health. doing the above 3 steps successfully pre authorizes you.
- your PCP must refer you to a participating weight loss surgeon. you then take that referral your PCP gives you to the weight loss surgeon you and your PCP choose (preferably together) to schedule your surgery.
- there are no copayments for the surgery under Horizon NJ Health. the surgery is 100% covered by the insurance company, HOWEVER dietary supplements and devices required after the surgery are NOT covered under plan D. they ARE covered under plan A.
hope this helps! i will be speaking soon about seeing if WLS is right for me.
I had gastric by-pass in 2003...the DRS who saved me called it a abdomel castrophie. I was in a coma for 3 mo. and in the hospital for a total of 8 mo.. I was in septic and volmic shock. I needed 79 units of blood, was left open for over a year. well now I have Horzion nj health and need emergency surgery....I have a stricture between the stomach and intestine, gall stones, sludge, an ulcer and adhesions. I can not fin a surgen to help my gastro dr says it must be a bariatc dr. I am now can not eat any food at all...living on milk and boost. good news i am down to 130 lbs up 5 from 2 weeks ago but losing again...someone please HELP
Hi, my name is Danielle and I had my RNY in 2007 and had a horrible outcome also. I was in a coma for 7 1/2 weeks, with ARDS, sepsis, MRSA, you name it I had it, but not as bad as you. I am soon sorry for your situation. I was very fortunate and found this gastrosurgeon who specializes in bariatric surgery out at the University of Pennsylvania in Philadelphia, Pennsylvania. He literally saved my life. They did not think that I would make it and him and his team brought me back.
You really need to go see him right away. He is a wonderful doctor in one of the too 10 hospitals in the United States. His name is Dr. Steven Raper and his number is 215-614-0382. My husband and I can not stress enough how good he is. I'm also shocked right now that since you can't eat that they don't have you on TPN. That was the only thing keeping me alive at one point.
Please keep us posted and if you would like to ask me any questions or just want to talk please don't hesitate to e-mail me at [email protected] Good luck and God Bless.