Has anyone this year have any problems with humana approving them???

Hello well my Doctor told me to consider the surgery but my insurance at the time was VISTA. They said no. My insurance has changed to HUMANA i am not sure is this a good thing. Has anyone had any resent dealings with HUMANA. Thanks for the information. Joni

I'm not sure if you'd be willing to consider traveling some to get to a great surgeon but call Surgical Associates and find out if they can help. (352) 368-2828, Patrice Hinder. Keep me posted.

Hi Joni, I do have a humana ppo (medicare advantage plan) and my file was submitted in February and within 2 weeks I was denied because at times my bmi was slightly below 40, they stated I didn't do the 6 month supervised diet (which I did I am currently going on 9th month) and something about having no proof of a metabolic disorder (which I had all the bloodwork and testing that was recommended). With all that being said I have appealed and I am waiting on the results of the appeal. My situation is that the medicare guidelines changed in February about the same time as my claim was going through the system. So by the new medicare guidelines I meet all the requirements as they lowered the bmi to 35 or > with at least one co-morbidity. I don't know if this really helps you at all, the coordinators at Tampa General said that Humana is one of the easier companies to deal with, I just happen to run into some problems that I hope will be resolved shortly. Good Luck on your journey

Thanks so much for responding any input is helpful. Did you ask Humana up front before consulting a Doctor?

I have Humana Gold Plus/Medicare. I checked all upfront requirements through phoning Humana and reading their web site section under "Obesity Surgery". They now cover both the RNY & Lap Band under the medicare requirement that you have it done at a hospital & by a surgeon that has recieved "The Center of Excellence Award". So I just finished the required 6 Month Doctor Supervised Diet. I saw my surgeon, Dr. Rehnke. Monthly as my PCP did not have a scale that reached my weight. I was placed on a Super Atkin's Diet which consist of primary the same diet you will do Post-Op with No Carbs. I've lost 35 pounds since Christmas '05. Well I saw my PCP the last week in March at which he said he'd grant me my "Letter of Medical Clearence" by the following Friday. And they would submit it to Humana the following week for Approval to Receive the referral to use my surgeon for the RNY. I found on my space of Humana's site yesterday that I was Approved!! So now it's up to the Surgeon's office to Submit my records and Letter asking for Approval to perform the surgery. Which a friend of mine using the same Humana Gold Plus had her Approval the same day her records were submitted. I'm much bigger than her with a BMI of 75. So I'm looking for Approval shortly. Good Luck with your journey. And just don't try to take any suggested short cuts. The Insurance companies always know. Mike

Thank you so much this i encouraging. So should i have my pcp call or write a letter to Humana, or should i have the gastric doctors office call the insurace company? Thanks again Joni

Mike- Your post mentioned the recent medicare decision outlined coverage of the the RNY and Lap Band but you left out that Medicare also covers the Biliopancreatic Diversion with Duodenal Switch (BPD/DS) or as most of us refer to it the DS. Red

WOW To my suprise my Primary Dr.Kern wrote a letter that I thought was my Medical Clearence Letter to Dr.Rehnke. BUT it was a Request to Humana for my Approval to receive the Surgery. That was submitted last Thursday April 6th. Monday I had my "Approval For the Surgery" and it's now scheduled for May 10th. I have my pre-surgery test done on May 1st by my Primary and then upon passing everything he'll write another "Medical Clearence Letter" this one to Dr.Rehnke.