Humana requirements

no1mimmie
on 1/4/09 11:32 pm - Louisville, KY
I have insurance with Anthem (1st) and  Humana (2nd).  Anthem has denied me because they do not cover weight loss surgery in my policy (regardless).  Humana will cover but I am told they want you to do a six month supervised weight loss program first.  Here are my questions.
1.  Is they any way to get around this?
2.  What happens if you join a weight loss center (Weigh****chers, etc.) and your BMI reaches lower than required fro the surgery.  I have done Weigh****chers many, many, many times, but I always lose control and gain the weight back plus more. 
3.  Do you think they will approve if I have several letters from my doctors stating I should have the surgery?  I am trying to get approval for the lapband, so I won;t have to be off work but for a few short days.

Any advice you can give me, is much appreciated.
(deactivated member)
on 1/6/09 4:07 am - sunny, CA
You need to call up Humana and ask them if they will accept WW as a medically supervised diet (if you have records from WW and coinsiding doctors notes) that may be enough. Ask your insurance what exactly what you need to do to satisfy their medically supervised diet requirement.

If they say they will not accept WW then just start the diet asap. It really goes by fast. Make an appointment with your PCP right away and start going. Make sure you go once a month every month for 6 consecutive months. Your insurance might not require that it be consecutive but I've noticed it's easier to get insurance approval if you do it this way. Make sure your doctor documents everything you are doing during your diet (i.e low carb, how many calories you get in, and make sure you mention that you exercise, how many days a week, how long, blah blah blah).

Your insurance goes by the weight you are at the time you start your medically supervised diet, so it shouldn't matter if you "lose too much weight" and really what are the chances of that? How many times have we dieted in our lives and not lost any or much weight. Your doctor can't make you lose weight or follow you around to make sure you are following the diet. You just have to show that you are "trying" to lose weight.

Best of luck

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