Does anyone know ... ?

Does anyone know if the Humana Medicare Advantage Plans cover the Lap Band Surgery or any of the Weight Loss Surgeries? :-S

Melissa - Medicare issued an memo back in February that was the outcome of a couple of years worth of study into obesity surgeries. The memo stated that Medicare would cover three bariatric procedures: open and laparoscopic Roux-en-Y gastric bypass (RYGBP), laparoscopic adjustable gastric banding (LAGB), open and laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS) In order to qualify for any of these procedures Medicare beneficiaries must have a BMI greater than 35 and at least one co-morbidity related to their obesity and have been unsuccessful in past attempts at medical treatment of their obesity. Medicare will only cover these procedures when they are performed at facilities (and by surgeons) that are certified as either a Center of Excellence by the American Society for Bariatric Surgery or a Level 1 Bariatric Surgery Center certified by the American College of Surgeons. Now, how this decision fits into Humana's Medicare program I do not know, but it is certainly worth a telephone call to find out. Since most of these Medicare Plans claim to offer "extra" benefits, it would seem reasonable that they would offer the same level of coverage for bariatric surgery that Medicare offers. Red You can find the complete CMS decision memo at: http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=160 and you can find a list of the facilites with the Center of Excellence rating at: http://www.cms.hhs.gov/MedicareApprovedFacilitie/BSF/list.asp#TopOfPage You can also view a list of the COE facilites at the ASBS site: http://www.surgicalreview.org/locate.aspx

A friend of mine who has the Humana Gold Plus/Medicare has ran into a problem with this. Even though Humana does cover the banding now. Our local Surgeon Dr. Rehnke only does the Lap Bandings at his Hospital, the "Palms of Pasadena Hospital". Which is a "Center of Excellence" hospital. Which Humana just recently added and now covers too. But since Humana so newly added this to the list of Hospital covered. None of the local Primary Doctors who accept Humana Gold Plus have "Visitation Rights" to view or diagnose at the Palms. So they can NOT send any of there patients there. My friend is so depressed of this, she has decided to go to Greece to receive the Lap Banding.