Humana HMO vs University of Cincinnati

Hi everyone. I have Humana HMO, and am employed with UC. I've been told from Humana that basically the reason why they are saying 'no,' is because in their contract with UC, they specifically mention "no coverages" for anything having to do with weight loss. So, despite the fact that I meet all the guidelines for the insurance to pay, they still won't because of their contract with UC. I'm at my wits end. Any other suggestions?

Hi Kimberly, Did you ask if morbid obesity (as a disease) was covered? If there is an exclusion with the employer than there is little that can be done. I hope that is not the case . But, it is worth it to ask about morbid obesity. Good luck, Penney

Hi, I can tell you this. UC does have a very strict policy about what they will cover and what they won't. They will not cover ANYTHING related with weight loss even if it is for morbid obesity. Please know this is not Humana's decision. The powers that be at UC with regards to benefits make the decisions about what they will cover and what they wont. Every year they do this, then they get together with Humana and devleop the contract. Frankly, I work at Humana and was suprised that UC did not cover it on any of their policies. Sadly this is seeming to be the trend. More and more empployers are opting out of surgery for weight loss even though it may be medically necessary. I think it is their lack of knowledge that is doing this, they only hear of the problems and not the successes. I wish there were better news, but written exclusions can not be appealed. the only hope you may have is to write to your HR dept and the perosn in charge of benefits and fight for it to be a covered benefit for the next plan year, or see if they will give you a waiver. With the talented surgeons that UC has doing weight loss surgery and their track record you would think they would cover it. UC is actually self funded, Humana just administrates the plan, so they have even more control over what is and is not covered. Humana has very little to do with it other than the administration and paperwork part of it. Good luck...there are several people employed by UC that want to have the surgery, maybe all of you could get together and talk with Hr, remember there is strength in numbers. Sherri

Hi, do you know if all the Health Alliance hospitals are Humana and won't pay for the WLS, or is it just UC? Thanks Linda

Hello, I really don't know, I think it is just UC. THe only thing you you can do is ask HR. DO you work for the health alliance?