Insurance Exclusion Clause

Does anyone have Humana PPO? They denied me for the Lap Band procedure because they do not cover surgery for OBESITY. The exclusion states, morbid obesity or clinically severe obesity with BMI>40 and 100 lbs>IBW in correlation with medical necessity. I have hypertension, hypercholestrolemia, headaches, edema of lower extremities, possible sleep apnea (increase in snoring & will wake up suddenly to catch breath) with BMI 37 at 220#. What do I do next?

Katrina, Humana is tough. We in Louisiana are about to have a major government carrier, Tricare, switched to Humana and I have heard that they do not cover weight loss surgery. It's all in the wording of the exclusion! You should have someone who is familiar with the terminology of the insurance company to look at the denial and give you advice. I highly recommend Gary Viscio, an obesity advocacy attorney. He has had the surgery himself and fights tooth and nail for patients to be given the same opportunity that he himself has been given. I am the coordinator for an office here in Lake Charles and I must say that he has made my job more rewarding because I don't have to give bad news to half as many people. I hope he can help you. Gary's website is www.obesitylawyers.com. You should check him out. Good luck and keep your chin up! Marcie - Bariatric Coordinator Obesity Surgery Center of Louisiana www.obesitysurgeryLA.com

Hey Marcie, Thanks alot. Listen I did get info from Gary and I'm planning to utilize all info prayerfully in my favor. Sorry it took so long to respond. I am a third time grandma of the most beautiful 9lb. 9 1/2oz baby girl. So see, obesity is in the family (smile) but it's more cute on her than her grandma!