Question:
Anyone have Pacificare PPO Insurance & was approved for surgery?

Pacificare is stating that they will only approve those people in their HMO for the surgery (if medically necessitated). Unfortunately, they do not offer a HMO in IL for me to choose from. Therefore, my claim is not even being looked at as it is a medical exclusion, period. Does anyone have any info that they were ever approved with Pacificare under their PPO program who had a medical exclusion clause?    — Michelle P. (posted on May 31, 2002)

May 31, 2002
Well, I'm not sure about the medical exclusion part, but I have Pacificare PPO and was eventually able to get approval. They tried several tricks and dances but eventually persistance paid off. I had to go out of our area because there is no local surgeon who does bariatric surgery. It took about a year to jump through the hoops, call all the bluffs, get all the tests, etc.
   — kimlasavio

June 2, 2002
Hi Michelle: I have Pacific Care HMO/PPO and was approved. My "medical group" was actually the ones that made the decision for surgery. Pacific Care was very helpful. I am in California and I don't know if it is different here than in IL...You can e mail me if you want some further information.....my e mail address is: [email protected]
   — Joi G.