Have United - considering Humana

Hi all - I'm having a heck of a time with United Healthcare. The rep we're dealing with is a bit of a problem, in that with my company's EXCLUSION to any/all surgical and non-surgical weight loss means (including morbid obesity), there's just no way around them. She has told me a few times to be prepared to be denied, and have all the paperwork and documentation I can get my hands on, even though she knows it won't be approved no matter how many letters are sent (and by whom). SO - I'm considering switching to Humana ONE. I'll have to pay out of my own pocket every month, but it sure beats the hell out of not having the surgery. My big concern is the fact that my local WL center doesn't accept Humana. They do accept United (for those with the right policy); I really REALLY like the surgeon and the staff and the program coordinator, but if I can't get approved with United, I have no choice but to go with Humana. My big question is - if I've been denied by United for this surgery, won't Humana find this in their fact-finding investigation of me before issuing me an individual policy? I'm looking for any answers, or advice. I'm still in the middle of pre-op testing, and the program coordinator is supposed to send everything to United on Tuesday after my psych eval. Should I stop NOW and just apply for Humana before United rejects my request? Thanks everyone! Shannon Ashland KY Pre-Op BMI 44.4 / 284.0 (was 292.9 on 3/24 for initial consult)

I'd be careful, because when we (me and my husband) were looking for insurance, Humana one, and some others (anthem, etc) that you pay out of pocket for, do NOT cover WLS. I have a sister who works at anthem, and she said that 99.9% of those policies will not cover WLS. But, it's worth checking into again.. this was back in December, and we ended up paying for cobra, since my insurance would cover it. I would go ahead and let it be submitted to United Healthcare, myself. And just because this rep is saying "it'll be denied", my question is, what does your policy manual say?? I'd, like I said, go ahead, let them deny you, and see what your denial letter says. At that point, you can go from there. Just be careful with these other policies. The won't pay for WLS.... I am now 5 weeks post op, and have helped several with approvals with policies WITHOUT an exclusion, and if there is an exclusion for SURE (by the mouth of someone other than this "rep") email me and i'll send you a copy of an appeal letter i found online for someone with a written exclusion (written by an attorney).. it's from one of my online support groups... Email me anytime, ok?

Hi Shannon..... I'm from Ashland too.....How cool, email me sometime, I see Dr. Rodriguez in Louisville. I have had my 1st consult with him a few days ago so I'm just starting this too....Anywho, if you ever wanna chat, email me and we'll get together..... Sher