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#Doctors that accept horizon nj health full#
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Weight Loss Surgery for Individual/Family Plans

Contact your insurance company directly using the phone number on your insurance ID card.

#Doctors that accept horizon nj health free#

Click here to find a surgeon near you, then call or email them to request a free insurance review. Your local surgeon will usually be willing check your insurance for free.To find out whether weight loss surgery is covered by your employer’s plan, you have a few options:

#Doctors that accept horizon nj health full#

If you work for a company that has 50 or more full time employees, it is completely up to your employer to decide whether or not to cover bariatric surgery under your health plan.

Weight Loss Surgery for Health Plans Through Your Work

Full Bariatric Surgery Medical Policy for Horizon Blue Cross Blue Shield of New Jersey.

Contact Horizon Blue Cross Blue Shield of New Jersey.Horizon Blue Cross Blue Shield of New Jersey Contact Information and Full Medical Policy on Bariatric Surgery After all, these tests will be beneficial regardless of whether you move forward with surgery. While this may sound “sneaky”, it is an ethical practice. But if your doctor uses a general CPT code, it probably will be covered.

#Doctors that accept horizon nj health code#

If your doctor submits one of these claims using a weight loss surgery CPT code (Current Procedural Terminology Code), your insurance is unlikely to cover it. These are ordered for many reasons other than bariatric surgery and may be covered as a result. It’s all about how your doctor and hospital submit your claims to your insurance company.įor example, there are many non-bariatric surgery reasons for your doctor to recommend: You may be able to get part of the costs paid for by insurance even if weight loss surgery isn’t covered. If Your Policy Does NOT Cover It: Seek Partial Coverage These patients must demonstrate compliance to the bariatric surgeon through enrollment in a multidisciplinary bariatric program including psychological intervention nutritional counseling, and support group attendance. Since members are expected to be compliant with the postoperative requirements, members who have failed bariatric surgery because of noncompliance and wish to be considered for revision surgery must be actively reintegrated into an established multidisciplinary bariatric program. Repeat bariatric surgery or any subsequent modification requires supporting documentation which should at least include a clear explanation of the clinical circumstances as to why the procedure failed, the member’s BMI, and the results of any diagnostic tests or studies performed.

#Doctors that accept horizon nj health professional#

Copies of original medical records documenting pre-operative psychological evaluation and clearance for bariatric surgery provided by a licensed mental health care professional familiar with the implications of weight reduction surgeryīariatric surgery is NOT considered medically necessary for members under 18 years of age unless the member has already achieved full skeletal growth and has a life threatening co-morbidity (e.g., pseudotumor cerebri, severe sleep apnea, uncontrollable hypertension, incapacitating musculoskeletal disease, etc.).

The regimen should provide guidance on diet, physical activity, and behavioral and social support prior to and after the surgery

Copies of original medical records documenting participation in an organized multidisciplinary surgical preparatory regimen in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member’s ability to comply with post-operative medical care and dietary restrictions.

Copies of original medical records documenting previous participation in non-surgical weight loss program or diet program/plan (e.g., Weight Watchers, Jenny Craig).

Within the 12 months prior to the time of surgery, the member must meet all of the following requirements:.

Use this BMI Calculator to check your body mass index…

Hyperlipidemia (hypercholesterolemia and/or hypertriglyceridemia).

Pain and limitation of motion in any weight-bearing joint or the spine.

Chronic venous insufficiency of the lower extremities.

Insulin resistance or frank diabetes mellitus.

a Body Mass Index (BMI) greater than 40.

Diagnosis of Morbid obesity, defined as.

In order to be approved by Horizon Blue Cross Blue Shield of New Jersey for bariatric surgery in the United States, you must meet the following criteria: Contact your insurance company to confirm all benefits. Disclaimer: The information contained on this page may not include all components of your insurance company’s medical policy and/or may not be up to date.