Question:
PacifiCare PPO through PHCS Network

Does anyone have PacifiCare PPO through the PHCS Network? My mother lives in Oklahoma and has this insurance, which is actually out of Cyprus, California. Her policy has an exclusion for WLS, and we were wondering if there was anyone who has this same insurance with the same network who got the exclusion removed. If so, what was your experience? She wants to have the surgery, but we don't know how to get around the exclusion. Any ideas? Thanks.    — Kristie B. (posted on April 23, 2002)

April 23, 2002
Hi: I have Pacific Care PPO and mine had the same exclusion. But the key to it and with most ALL insurance companies is that this surgery is "medically necessary" for your life. They wouldn't think of denying you if you needed open heart surgery or something life threatening like that would they???? My "medical group" was the nightmare NOT Pacific Care. Pacific Care actually helped me get things going and approved. You can e mail me if you need any help or suggestions...... [email protected]
   — Joi G.