Question:
Do you think I can get around Select Blue exclusion?

My insurance brochure says under "What is not covered" - No benefits will be provided for services, supplies or charges: For nutritional counseling and services intended to produce weight loss". Do you think that this will exclude my wls if I'm morbidly obese and have high blood pressure (co-morb)?    — [Anonymous] (posted on February 6, 2002)

February 6, 2002
Hey, I know the answer to this one....I called them and they said that was more for Weight Watchers, weightloss meds and personal trainers, pregnant-woman urine shots (I kid you not, people do that!!!) However, if your PCP feels it is medically necessary, and you meet the criteria, they approve without much trouble at all. Hope this eases your mind.
   — Linda D.

February 6, 2002
I have Community Blue which is very similar to Select Blue. Talk with your surgeon about what is needed for the approval. Mine submitted everything to Highmark BCBS on a Thursday and I was approved by Saturday. I've also called them several times about questions concerning approvals, referrals, follow-up, ect... and they have been very easy to work with. My experience with all the Highmark BCBS products and others in our area has been that Highmark leads the others by miles, they have always been polite, they have the Healthplace classes for support & education, and they have covered just about everything!
   — Sue F.

February 7, 2002
That exclusion relates to programs like Jenny Craig and Weight Watchers or even a hospital based diet program if the diagnosis is just "obesity". It doesn't apply to wls or to medical treatment for "morbid obesity".
   — [Anonymous]

July 8, 2002
I've been working w/the group at COMPASS, used to be IMAGES, and they've confirmed that the BCBS-TX exclusion isn't iron-clad because the medically necessary clause has worked, and they're working with me to get approval based on that. I know there are several who've tried to get past this based on a LOMN and were denied, but my case-worker lady seems confident based on the information provided by her contact at BCBSTX. See below: Dear Lynda, I spoke with Lettie at Blue Cross today and was told that they will consider this surgery if medically necessary, however as you have an HMO they will not allow you to go out of network. I noticed that you stated that you will roll over to PPO in September. I would suggest we wait until after September 1 to submit the letter of medical necessity for approval as they will certainly deny it due to being out of network. Please let me know how you would like to proceed and thanks for letting us know that they will consider this procedure. Up to now we have always been told that this was a "definite exclusion" on this policy even with medical necessity. Thanks and I look forward to hearing from you. Sheridan at Compass GOOD LUCK EVERYONE!! :)
   — Lynda L.