Question:
This is my Blue Cross California Care Exclusion
:"Obesity--Services primarily for weight reduction or treatment of obesity. This exclusion will not apply to treatment of morbid obesity as determined by BC HMO or the member's medical group if the medical group authorizes the treatment in advance as medically necessary & appropriate." Please excuse my ignorance, but does this mean if I am morbidly obese they will cover the surgery if medically necessary? Without the word "surgery", I don't know if they're talking about "treatment" with diet pills or Jenny Craig program or what. Thank you in advance for any interpretations!!! — [Anonymous] (posted on March 1, 2002)
March 1, 2002
I THINK it will cover the surgery, as long as your medical group will
authorize it. Some if it, I think, will depend on what they consider
'medically necessary'. That phrase is open to a wide range of
interpretations. I'd make an appointment with my PCP and see what he/she
says. Good luck.
— garw
March 1, 2002
I have Blue Cross California Care 100% HMO and I just had my surgery on
2-8-02. I didn't have a single problem with approval and I didn't have any
co-morbidities but my BMI was over 40. The beauty of the whole process for
me was that I was expecting a battle to get the type of surgery I wanted
but instead I got approved for that very surgery with the very surgeon I
wanted. I have only paid for the original $10 co-pay to my PCP (Whom I had
only seen once before I asked about the referral) and $10 to the surgeon
for the consultation. I could not be happier with Blue Cross.
— valiciah
March 1, 2002
P.S. Blue Cross will not cover Lindora or Jenny Craig or pay for diet
pills...I tried all that...Surgery is the only treatment they cover for
morbid obesity. I called Blue Cross to ask about it all and that's what the
rep told me..she also told me the procedure to get the ball rolling on the
surgery consultation and approval. Give them a call and you'll be able to
get clear on what you need to do.
— valiciah
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