Humana for State Employees Question

I have already had LapBand surgery, but I have a friend who is interested but doesn't know if her insurance would cover it or not.  We looked up the info online on her plan and it does look like they cover it, but only for a BMI of 40 or more.  Her BMI is 36.6, but she has multiple comorbidities.  Does anyone know if they cover a BMI of 35+ with comorbidities?

she will have to have 2 comorbidities from a list of 5 I think.  6 months of office notes for visits to her PCP acting as a medically supervised diet.  Also a letter of medical necessity from her PCP.  I am sorry but I am having a hard time remembering the list of comorbidities but its like: diabetes, sleep apnea, ..........you can look it up online at the kentucky health plan website.  She has that info from when she signed up for her insurance.

I had my Surgery recently and it covered it all except for like 300.00 that is the bill I got in the mail the other day...

I had to a 6 month plan with my primary doctor and then went to St Joe seminar and then set up appointment with the insurance gal and she gives you a paper to fill out.. I only had Diabetes and Sleep Apena.. took about a year to get to the surgery but it went fast! During my 6 months with my primary doctor I had the sleep study and had bunch of other tests done.. So it went by fast! Good Luck! Jennifer

I looked all through the coverage info again and still couldn't find any provisions for a BMI under 40.  I'll tell her to call the customer service number on her insurance card and ask about it.  Thanks for your help!

I work for the State and have Humana PPO and it covered mine! There is a phone number on the back of her insurance card that she can call Monday thru Friday During business hours and ask! They are really nice and answered all my questions!

Good Luck :)

Jennifer

I was rejected from Humana with a BMI of 51.  They said I did not have complete records of a 6 month weight loss with my doctor. I am trying again.  I also have sleep apnea, congestive heart failure, and degenerative arthritus,

Yes, Humana requires 40 BMI or 35> and 2 co-morbid conditions.  Theres is a list of them.  Before I started going to the Dr.  I requested a copy of Humana's policy.  It's easy to understand...that's probably her best bet.  Also you have to do a six mo. program with your family Dr. and a nut.  They are pretty specific on that I'm told that you have to go every month without missing any appts, but some people hear said they were approved before the 6 mo. 

Okay, thanks.  I know she has high blood pressure, depression, and problems with her thyroid.  Are those on the list?  Her doctor has started her on some medication and is monitoring her weight loss efforts.  I'll tell her to make sure she goes at least once a month. 

I know for sure high bp is...I'm not sure about the others...I know sleep apnea, diabetes and high bp and I know there are at least two more but I can't think of what they are??

Thanks!