Services Not Covered

The BCBS PPO does not provide coverage for:

Ambulance services unless necessitated by an emergency or medical necessity or authorized by Blue Cross Blue Shield for transfer from one facility to another
Any claim submitted more than two years from the date the service was rendered
Blood and blood products
Care for military service-connected disabilities for which the member is legally entitled to treatment or services
Charges in excess of the plan maximum amount or other limit
Commercial diet plans or weight loss programs
Cosmetic procedures, except when medically necessary and considered medical care under the Internal Revenue Code
Cost for any services for which the member is entitled to treatment at government expense or under Worker’s Compensation or occupational disability
Court-ordered examinations and services
Custodial or domiciling care to assist a member in the activities of daily living or provide room and board, training in personal hygiene and other forms of self-care; personal care in the home except when medically necessary as part of a treatment plan for a medical condition
Dental services, including periodontal, restorative, and orthodontic services
Educational services (including problems of school performance) or testing for developmental, educational, or behavioral problems except as medically necessary under an early intervention program
Equipment for environmental control or general household use, such as air filters, air conditioners, air purifiers, liquidizers, bath seats, bed pans, dehumidifiers, dentures, elevators, heating pads, hot water bottles, and humidifiers
Eyeglasses, contact lenses, and fittings. This exclusion does not apply to contact lenses that are required due to cataract surgery, covered corneal transplants, and keratoconus.
Health care services that are not medically necessary
Health care services that are considered experimental
Health care services that are considered obsolete and no longer medically justified
Health care services furnished to someone other than the member
Infertility services for members who are not medically infertile
Missed appointments
Non-covered services, even if pre-certification was mistakenly given
Non-durable medical equipment, unless used as part of the treatment at a medical facility or as part of approved home health care services
Orthotics
Osteopathic manipulation, electrolysis, routine foot care, biofeedback, pain management programs, massage therapy, and acupuncture
Personal comfort items
Physical examinations for insurance, licensing, or employment
Private duty nursing
Private room unless medically necessary
Refractive eye surgery
Rest or custodial care, personal comfort or convenience items
Reversal or attempted reversal of voluntary sterilization (including procedures necessary for conception following voluntary sterilization)
Sensory integrative praxis test; testing for central auditory processing
Services incurred after termination of coverage under the plan
Services incurred prior to the effective date of coverage
Services for which no charges would have been made in the absence of coverage under this plan
Services not specifically described on this site
Services not within the scope of the physician’s, provider’s, or hospital’s licensure
Services for any person who is not covered under the plan when the services are rendered
Services or supplies given to you by anyone related to you by blood, marriage, or adoption, or who ordinarily lives with you
Surrogate pregnancy (any form of surrogacy)
Temporomandibular joint dysfunction treatment limited to medical services only
The portion of the charge for a service or supply in excess of the usual, customary, and reasonable (UCR) charge
Weight loss programs or charges for weight reduction except when extreme obesity adversely affects another medical condition and treatment is medically necessary as determined by the plan

For a comprehensive list of services and conditions not covered by the BCBS PPO, please refer to the description for the BCBS PPO available from Human Resources.