Denied by Humana

Today I received my first denial for lap band surgery.  While I was told by friends to expect a denial the first time, I am disappointed.  I thought I did everything correct. 

I am now going to appeal, but first just wondering what others experience has been with appeal and humana.

The denial states "available documentation does not indicate that this patient has a primary care physician who has followed her pre-operatively, agrees that she should have the procedure performed, and will follow her post-operatively after procedure is performed."

This to me sounds like maybe some information was not submitted to them.  I did the 6 month supervised diet, and have the bariatric referral form from my primary care doctor.

Any comments?  Thanks.

Contact the Surgeons's office and check to see what they sent to Humana, also you might call Humana and ask them what they have recieved.   I would start with those 2 things first

Hi Vicki and thanks for the response.  I have contacted the surgeon's office and it seems that there was a problem with one of the forms.  It has been resubmitted and I am just waiting to hear back from them.  Now, all I can do is hope that Humana will be happy with the resubmittal

Really? Is it common to be denied the first time? I have Humana-KY state employee insurance. And I am trying to have the LapBand surgery.

I am a state employee too and this was my first time and I was denied.  I have friends that say a denial on the first time is common.  As I understand it, a lot of times the denial is because of something missing from the paperwork, so this could be the case.  Good luck to you.