Very Important update to the Horizon BC/BS of NJ Plan that may affect you!

Policy Number: 022
Effective Date: 06/19/2010
Original Policy Date: 06/22/2001
Last Review Date: 07/13/2010
Date Published to Web: 05/18/2010

• The requirement for documentation of adherence to a 6 month diet has been removed!!!
• Documentation of previous participation in conservative (non-surgical) weight loss program or diet program will allow patients to have Surgery as soon as they are Medically cleared and have participated in a Psychological and Nutritional Evaluation.

The revised Horizon policy is attached for your review. It States:

D. Within the 12 months prior to the time of surgery, the member must meet all of the following requirements:
1. Documentation of previous participation in conservative (non-surgical) weight loss program or diet program/plan (e.g., Weight Watcher, Jenny Craig).
[INFORMATIONAL NOTE: Programs supervised by a registered dietitian may not be a covered service under a member's contract.]
2. Documentation of 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. The regimen should provide guidance on diet, physical activity, and behavioral and social support prior to and after the surgery.
3. Documentation of pre-operative psychological evaluation provided by a licensed mental health care professional familiar with the implications of weight reduction surgery. (Please note that psychological testing is NOT included in this requirement.)