Question:
State of California CalPERS PPO Exclusion

Hello: Well I was very excited because I may be covered by a new PPO insurance, but I think there is an exclusion. I thought when I scanned the archived posts that I saw that the State of California CalPERS PPO which is done by Blue Cross did pay for gastric bypass. However, when I looked at the online EOC for 2003 for CalPers PPO "Pers Care" it does indeed say "Weight Control. Any program, treatment, service, supply, or surgery for dietary control, weight control, or complications arising from weight control, whether or not prescribed or recommended by a physician, including, but not limited to: a. excersize programs (formal or informal) and equipment; b. surgeries, such as gastric bubble, gastric stapling, or liposuction". I also looked at the PERS Choice plan and it has the same exclusion - looks pretty bullet-proof. Does anyone with a State of California health plan have any comments? I thought I saw posts of people with State of CA BC/BS being approved for surgery. Did they recently add this exclusion?    — w8free (posted on April 1, 2003)

April 1, 2003
Elizabeth~~ I have Pers Choice through the State of CA. Yes they do have an exclusion and always have BUT......it does not apply to you if you are morbidly obese!!!!!!!!!!!!! I had my surgery last September and got insurance approval in 3 days without any problems. You have to make sure that all the pre op labs and tests needed as well as all the office visits to your surgeon are coded as 278.01 which is the code for morbid obesity. I didn't have any co morbid conditions I qualified just based on my BMI. I have a lot of information on my profile about how the insurance stuff worked for me if you are interested. If you have any questions email me at [email protected] Wendi Open RNY 9/19/02 down 115lbs
   — lovemonterey