humana ppo

Ok... I just got off the phone with the my insurance (humanna ppo) and I was told that to be approved we had to do all the tests and then submit it to the insurance and prove it was medically necessary... now that isnt a problem except that they wont pay for the tests to prove it is necessary...... has anyone else faced this problem before with this insurance?  if so... what can i do???  

Darlene

yes they usually tell you that but have the dr. submit anyway cause they told me the same thing and they ended up picking it up

I have Humana PPO and had to do the 6 month doctor managed diet.  Other than that I didn't have to do any special testing.  Did they say what kinds of tests you have to have done??

Well unfortunately I just found out that we are not able to get approved. After being told over and over again that if we can prove it is medically necessary then they would cover it even with an exclusion....  The lady explained it to me like this.. The employer went shopping for the items they would cover and put them in the cart... And they didn't choose to put wls in the cart and even if we prove medical necessity they cant help us.... We are so heart broken!!!!  I haven't seen my husband this depressed in a very long time...

Oh sweety I am so sorry, however you might just check with Kelly and her husband at www.obesitylaw.com see if they can fight the exclusion other than that you would have to be self pay

I look at it like this.   i had to fight my insurance to get approved but had my mind made up if they didnt husband and I said we would either take a loan against our IRA or 401 or just cash the 401 K in that my life was more important now cause if I didnt get the weight off I would not live long enough to even enjoy the 401 K in my golden years.  So you have to look at is it worth the risk ????

Darlene,
Check with your surgeon to see what options they can offer. The band manufacturers have a finance program that they are pushing for the lap band but they will also cover RNY if you ask.  Your 401k or other IRA can be tapped (if available) and since the WLS will cost around $25,000 that should be more than the percentage of your adjusted gross income to allow you to take the medical deduction. I had the exact situation with the exclusion and decided that I'd look at it like buying a new car. I'm now saving enough money from passing drive-throughs that I'll be back to even pretty quickly. Some people have looked for a new job based on insurance coverage but I'm not sure I'd want to try that. There are options and you need to balance what it will cost (in dollars and in health) with where you'll be in a few years without it. It's a personal decision and not for everyone but there are ways to get it done.
Good luck,
Jim