Hit a road block with Humana

Hi Everybody, I have been so upset today, I have cried all afternoon. I have Humana Gold Classic Insurance. Next Wednesday will be my 5th visit for my 6 month supervised weight loss that is required by my insurance. I have no problem doing that. Why I am upset is that my surgical consult with Dr. Gallagher (Dr. Murr's) partner was supposed to be tomorrow at 9am. Today I got a call from my primary care physicians office that Humana will not authorize the surgical consult until the 6 months is completely finished which won't be until January 18th. I have had this appointment scheduled for tomorrow for the last 6 weeks and called for the referral about the same time and they just let me know all this today. I had my heart set on going today and am so disappointed it isn't funny. I know it is just two more months and to just hang in there but I get so tired of fighting for everything. Nothing comes easy for me. Also I have already spent over $1000.00 on this venture and I am so afraid I am going to continue and follow this through and then when I am done with the 6 month supervised diet they are going to deny me because my BMI is only 37.6. I don't mean to complain but I am just so disappointed and down tonight. I really thought I was on my way, but two months right now feels like 2 years. By the way my new appointment with Dr. Gallagher is February 3rd now. I hope you all are doing well and again I am sorry for being such a downer tonight. Patty p.s. has anyone else had humana and run into this that you have to have everything done just to get the consult???????????

I have Humana POS and am going crazy with them. My BMI is 42, and my chart is in medical review at this time due to the fact that my contract is so strange. Under benefits the surgery is listed as it requires that my physician submit clinical information before pre-authorization may be obtained and it lists Stomach bypass for weight reduction. HOWEVER, under limitations and exclusions it is listed as Any treatment to reduce obesity including, but not limited, surgical procedures. I am getting an appeal together now, including the part that I am not OBESE, I am MORBIDLY OBESE... there IS a difference and the precert lady in the dr office is the one that mentioned that as a possible loophole. I will hire an atty for this if it does not get approved either upon the submission to review now, or the appeal. This is crazy. I have so far in the past 14 years had my gall bladder removed and a hysterectomy, and if I do not get this weight off I will probably need joint replacement in knees or hips. I was born with a dislocated hip and it does bother me quite often. I can't walk a lot because my feet hurt from heal spurs. Not to mention that I get winded easy. I have to walk up 2 flights of stairs at work everyday, and that is not easy either. I am so ready to get this overwith and let my new life start, they just need to stop standing in my way. All of my precerts are complete from the psychologist, nutritionist, cardiologist, pulmonologist, gastrologist and only thing left is the lab work... what would that be called that ends with IST? Hope you have good luck.

=== and only thing left is the lab work... what would that be called that ends with IST? === phlebotomist

Humana is the insurance company that the government uses, right?? Humana, like all the other insurance companies really, are sticklers for detail and they will follow the terms of their written policy to the letter. Don't even THINK about trying to cut corners, because you'll only be wasting your time (not to mention driving yourself crazy). Just resign yourself to having to jump through the hoops - everybody has to do it. I really, really hate to even THINK about it, but you'd better check your policy now, if your BMI is only 37.6 because usually (notice I said "usually", not "always"), insurance companies require a BMI of 40 or higher or a BMI of 35 IF you have certain specific co-morbidities. The co-morbidites generally have to be potentially life-threatening. I'd really hate for you to not be qualified and be surprised about it. If you are qualified, then remember that although you're not happy about all the red tape, everyone has to do it and it's really a good thing, there for your protection. If you want it badly enough, you'll do what it takes!! Hang in there! Jan

I have the Humana Gold Classic (as of Jan.1st to be known again as Gold Plus) with Medicare too. I'm in my third month of the 6 months required. I'm using Dr.Rehnke in St.Pete and have already had my first consult with him. At that time he put me on a Super Atkins Diet. The first month I lost 17 pounds. But was then informed that there is a little stipuation hidden in the paper work. If I lost more than 10 percent of my initial BMI (76 - 10 % = about 50 pounds) That I will be denied the surgery stating that I should just loss it all by dieting. So the second month I gained back 12 pounds and I could feel it. So I've gotten back on the program to lose. And both Dr.Rehnke and my PCP Dr.Kern have stated they will write appeal letters if Humana denies me. Check for this clause in your requirements. I now weigh in at 595 lbs. Good Luck and keep movin' Mike

Well i am waiting for my denial letter to show up, Humana said Wednesday morning that I was denied due to the exclusion in the contract. I also found out for sure that the girl my soon to be ex works with had the surgery with the same insurance in July. She went to a different hospital, and got it all approved first time. This just isn't fair. Her bmi was 44 and mine is 43. She has high blood pressure but only minimally, i have reflux, mild high blood pressure, major heart problems in the family, have allready had a hysterectomy and my gall bladder removed. I also have alot of joint pain, and heal spurs. She is a fire fighter paramedic and got around alot easier than I. So with the same policy through the same company of employment, both humana pos, how can she get approved and I get denied.

When did the girl that works with your ex have her surgery? I have Humana EPO and had my surgery back in March 2005. My employer is big enough to have a onsite Humana Rep in our office. She told me that Humana changed all their criteria in April of 2005. Even though my company is self-insured with them (basically we tell them what we want covered), they still changed the criteria. Several people in my organization have been denied and have had to appeal. Some have gotten it overturned. Find out if there are any exclusions in your company's policy. I was not required to have a 6 months diet plan. But I went ahead and did it anyways before I had my surgery consult so I had it just in case. I only had a BMI of 38 with 3 co-morbidities (hypertension, joint pain, excessive pedal edema) and I was approved by Humana. Keep fighting. Don't give up.

Hi Laurena, I know it is hard to wait but I have always relied on God to sometimes make the decisions for me. Sometimes things happen for a reason. Sometimes we don't understand the reason until later. Just for peace of mind remember to keep your head up!!! This will happen for you if you want it bad enough! Best Wishes.......... Cyndi