Can't seem to get a copy of EOC

[Brianna]

Hi all, I am working on my pre-op requirements for a VSG to DS revision. I've called my insurance member services number 4 times now trying to get a copy of my "EOC" or the specific bariatric policy for my plan and no one can help me! It's like these people have no idea what I am talking about. All they keep telling me is the typical "bmi over 40, psych eval, etc". They don't seem to understand that I want the specific policy for my specific coverage. And every time they transfer me to a higher level, no one answers! I have Medicaid in NJ, the Horizon NJ Health plan. On the Horizon NJ Health website, I found a link to their "Medical Policies Manual". Is this the same thing?

https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf

According to this, they cover revisions if you meet the criteria and show an ability to be compliant with the post op requirements. But it says it's the "uniform medical policy" guide so I'm not sure if my specific plan could be different? I'm just so confused.

 

[southernlady]

DianaCox Larra

 

[DianaCox]

You probably have to contact Medicaid - they hold your particular contract.

 

[Larra]

I like DianaCox's advice, but would also suggest that, if possible, you find one person at your insurer who can be a contact person for you instead of talking with a different representative every time. You would then have someone who might be able to get you connected with someone higher on the food chain. Maybe.