Humana- Kentucky employees plan

Does anyone had the Kentucky Employess insurance through Humana?  If so, did you have any problems getting approved?  How quick are they. I know I have to do the 6 month diet under doctor supervision but Iam just wondering how they are at approving after that.  Do they play the usual, deny, appeal games that some insurance companies play?  What do I have to look forward to?

I didn't have any trouble at all getting my approval from Humana.  I started my 6-month diet 2 years ago in January, finished it in July, submitted my paperwork (through the surgeon's office), and got my approval 2 days later.  My doctor's office was in close communication with Humana, so I knew exactly what tests they needed and what results they expected from my 6-month diet and its documentation. My profile details much of my approval process, so you can read it if you want to know more about how things went for me. Good luck!  The 6-month diet seems like it will take forever while you're going through it, but it will be over before you know it; in retrospect, it was such a short time to wait for my surgery.

Thanks, it's encouraging to hear that there isn't much trouble with Humana.  I started my diet with my PCP in  March.  She seems to know quite a bit about what they want also so I feel pretty confident with her.  Thanks for the info!!  I really appreciate it.

   Hi Trina,

 I too am a state employee, it seems like forever having to wait the 6 months. the key is what ever you do DONOT miss 1 month not even a day late they'll make you start the whole process over again. they didnt tell me it had to be 6 months in a row. Then I went nov, dec, jan,missed feb i had to reschedule but went march 1st NO GOOD i missed feb had to start over march was month 1 again!!! I had Dr. Shina they were wonderful they did all my paper work for me My family Dr. is who I seen for my 6 months. they key....... detailed notes every month. Shina had them faxed to his office so they could go over them monthly instead of waiting till 6 months is up and find something is wrong. tell your DR. everything all your aches and pains, joint swelling, sweating under your boobs?? believe it or not thats a yeast infection short of breath, can't sleep good. all those are comorbidites tell the Dr about all the diets youv'ed tried the more info when they submit your packet to the ins company the better. Shina submitted mine 3 days later i got approval. couldn't believe it  well good luck to you   dont give up!! Tammy  

thank you!!  Everyone is so helpful on here. I would hate to have to start all over again.. I wish they would do away with that rule.... it's really ridiculous!!  Did either of you lose any weight during that 6 months?  Do they want to see if you CAN lose it or what... I don't understand their reason behind it.

Trina,

Yeah, Dr. Shina told me he wanted me to lose 25 lbs. I told my pcp she gave me some diet pills I took them for the whole 6 mos. I only lost 12lbs. but, to be honest I was like you I didn't want to lose weight for fear that they would think I could do it w/out the help of the surgery. So, thats just proof that diet pills dont work!! thats just their way.It's pretty dumb huh? Dont give up it won't be long. I had my ryn on 12-07-07 and have lost 68lbs. only regret I didn't do it sooner. your in good hands here, this is awesome site!! good luck to ya!!!!!!! YA know there is a support group held the last thursday of the month at suburban at 6:00p.m. you dont have to wait till ya have your surgery. You should come!! theres is a lot of Gellars' patients there also, also a dietician and usually the psych Dr yull see her when you have to go to your seminar. every body ask all kinds of questions see ya there Tammy

Trina, I felt I needed to keep my BMI over 40, and it was 40.2 when I started my 6-month diet, so I felt I really couldn't lose much.  I lost a pound and then gained a pound, then lost 2 pounds and gained a pound.  I did that throughout the 6 months and ended up being down a pound or 2 from my starting weight.  My doctor documented that I was faithful in keeping my appointments and  exercising and trying to lose.   I also used that 6-month period as an opportunity to stop drinking carbonated and caffeinated drinks and to practice the new rules for eating (no drinking with meals, taking tiny bites, chewing extra-well, eating protein first, etc.).  By the time my 6 months were over, I was in good shape to have my surgery and use my new habits. Are you having RNY or the band? Kathy

Most Definitely the band... I am scared enough of that.... I would never (I don't think) have the nerve to go for the RNY.  My daughter did it in 2006 and has lost 170 pounds.  She was much larger than I.  My BMI is 39 now.  I have already stopped diet soda.  But I am drinking Diet Green Tea. do they allow that?  I just want to get his done!!!  I am so miserable.

that's my plan - I started my six month diet last June and submitted in November.  Once they had everything they needed from me I was approved that day.  Just make sure you have those notes from your PCP including that you spoke about weight loss, your letter of medical necessity, your psych and NUT evals, hmmmm I think that was it.  My surgeon's office took it from there, best wishes I hear your doc is doing Vertical Sleeve Gastrectomy now, that's great that our area is moving into the future of bariatrics

yes, he does them, but I don't think the insurance will cover it yet. He did talk about it at the seminar. I have a visit Wednesday with a dietician and therapist, don't they do the psych eval at that time or do I have to schedule one on my own seperately?