Question:
Can anyone supply me with BCBS definition

Need the EXACT wording as found in the plan booklet definition of experimental and investigational treatments I dont have a booklet at this time and any help would be greatly appreciated    — Lisa F. (posted on February 16, 2003)

February 16, 2003
Hi there! I have Empire BCBS and this is what my insurance handbook says, word for word in the Glossery: "EXPERIMENTAL, INVESTIGATIONAL OR UNPROVEN SERVICES - Experimental, investigational or unproven services include medical, surgical, diagnostic, psychiatric, substance abuse or other health care technologies; supplies, treatments, procedures, drug therapies or devices that are determined by the claims administrator to not have been approved by the U. S. Food and Drug Administration (FDA) to be lawfully marketed for the proposed use. For example, a drug that is the subject of an ongoing Phase III clinical trial would be considered experimental, as would be a drug that has been approved for use against breast cancer but is being used to cure influenza. Additionally, any health care technologies, treatments, procedures or other processes that are not subject to FDA approval are considered experimental if they are determined by the claims administrator to be not sufficiently prevalent in the medical field or not sufficiently reviewed in the peer-review literature." Hope this helps!
   — cherryswitch

February 16, 2003
I have BCBS PPo and my 2003 booklet states in the exclusion section: Obesity: Services primarily for weight reduction or the treatment of obesity are excluded. This exclusion does not apply to surgical treatment of morbid obesity as determined by us if we authorize the treatment in advance as medically neccessary and appropriate. I hope this helps you in you quest toward WLS!!! Good luck!!!
   — Brandy C.

February 16, 2003
Thanks yall both were of great help
   — Lisa F.

February 16, 2003
You need to look at YOUR policies book as they vary drastically from policy to policy and state to state. You employer has the option to add or subtract things, which changes their standard policy a lot. The policy I have is one of a very few that BC/BS of WI has that allows more than a 34 days supply of meds for 1 co-pay. If my doctor writes a script for a whole years supply on one fill, I could actually get that for 1 co-pay. I usually limit it to a 90-day supply. <p>My policy excluded all services for treatment of obesity except morbid obesity. All I had to submit was a letter from the surgeon indicating some of my co-morbs and requesting pre-approval, a psych eval from my psychiatrist and a detailed diet history and I was approved - but I did way more than qualify.
   — zoedogcbr