Problem with Humana

Surgery on hold. Scheduled for 7 a.m. 11/11/04 and when I checked with Tricare's new carrier they told me they didn't cover Gastric Bypass. Unfortunately they sent me a new book and on page 27 it says "to be covered, you must be 100 pounds over ideal body weight and have a co-morbidity or 200 percent of ideal body weight with no co-morbidity." I fit the criteria. We have gone back and forth all afternoon. They took it to their legal department. Last call from them is they will okay if Dr Barnes does rny -open. Well Dr. Barnes has a contract with them and they are trying to tell him how to do the surgery. So he is now involved because they are not honoring his contract. To top all this off I am the first one that the request has been made for this surgery.God I hate to be first. My husband says I am getting this surgery. Lets says I was beside myself this afternoon. I have to drive 125 miles, had the dogs reservation at the pet inn, cleaned my house, packed suitcase. Pray tomorrow is better. The ups and downs will kill you. Bobbie

I will say a pray for you tonight and I wish you well with your surgery.Teesha

Hi Bobbie, I will pray for you to get the help you need. I have Humana with Ochsner, and I got a letter that states they will no longer pay for this surgery also. I am having my surgery Nov.23,2004, mine is covered for now, I hope no last minute happenings here. Keep on them, and know we will all pray for you. Marilyn

Can someone explain the process to me about humana and ochsner. i am an employee at ochsner and humana takes over for my benefits in january. i thought it wasn't until then that they won't cover it. what is going on.

I wish you luck! I have Humana but because I work for the state, we have an exclusion policy on all bariatric surgeries. I've inquired and it is excluded at the state benefits level. This is so crazy because they spend a ton of money on me & my meds & tests because of diabetes. Keep me posted. Jeanie