Horizon BCBS of NJ and Sleeve Gastrectomy

Hi,

 

I am trying to figure out how get going on a gastric sleeve operation. I called my insurances and they said that the do not cover the procedure, but I have read online of people who were able to gt it despite BCBS not covering it. Any idea how this works?

 

Thanks

Joe

People can pay for the surgery themselves if their insurance does not cover it. I have horizon BC/BS and had the surgery back in January. I guess it differs upon the individual plan terms and conditions, however whether or not they cover it.

Have you gone for a consult yet with a doctor? Sometimes they call people and get more precise insurance information. I had to go through several steps and meet certain conditions for them to cover it, but finally they did cover it.

Does your company have the rider coverage for WLS? Some companies don't pay for the additional coverage.

Joe-

Coverage depends on what was purchased by your employer.  My VSG was covered by Horizon BS of NJ.  My doctor was a participating doctor and I had very little out of pocket.  Call yiur insurance.  There is a number on the back of the card for member services.  See what is covered.  Good luck.

Nancy

I have the same insurance and they cover WLS at 100% if you're in network, 80% if you go out of network. The requirements weren't tough to meet either. Some companies make you wait 6-12 months but I had surgery less than 3 months after my initial consultation. Most of the requirements I had to complete were imposed by my doctor's program. My doctor has someone on staff whose job it is to liaise with insurance and break the numbers down, so I would recommend finding a practice with someone like that. Insurance makes no sense to me, so I was very happy to have someone else worrying about the logistics.