Recent Posts
Topic: RE: Denied by Humana
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
Topic: RE: Humana-KY state employee
You just need to make sure that you meet all the requirements to be eligible and approved if you do that its not a problem. Your surgeons office should have all the medical policy guidelines from Humana. Humana has a special united dedicated to Bariatric Surgery approvals.
Topic: RE: Humana-KY state employee
Is it hard to get approved for the LapBand? I was reading a post where a woman was denied the first time, and she said that was normal to be denied by Humana. I guess I am just worried because BC BS of PA denied twice (the old insurance I had).
Topic: RE: Denied by Humana
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
Topic: RE: 5 year weight history - BMI under 35
I have UHC as well. I think it depends on your plan, but with ours I have t ocome up with the 5 years weight history to prove a BMI of >35 plus comorbitities. Mine would hypertension.
I also have to get a letter from my PCP to my surgeon explaining why he thinks this surgery would be beneficial for me.
Then, I have to have my consultation with the surgeon. Once he recommends a surgey he will submit my 5-year history, letter from PCP and his letter of recommendation to UHC. From what I've heard the approval/denial process through UHC is fairly quick as long as all your paperwork is together.
I also have to get a letter from my PCP to my surgeon explaining why he thinks this surgery would be beneficial for me.
Then, I have to have my consultation with the surgeon. Once he recommends a surgey he will submit my 5-year history, letter from PCP and his letter of recommendation to UHC. From what I've heard the approval/denial process through UHC is fairly quick as long as all your paperwork is together.
Topic: RE: 5 year weight history - BMI under 35
I am still in approval process. I have UHC. I do have co-morbidities also.
Topic: RE: 5 year weight history - BMI under 35
She did have a 4 year history of BMI over 40. Our insurnace requirements were to have a BMI of >40 with no co-morbidities or >35 with at least 2 co-morbidities. She was denied due to lack of 2 year history of obesity as defined above. the reason being, originally 4 year history of proof of obesity was submitted, but within those 4 years, she had an office visit where her bmi dropped below 40 during one of the years. But she also had a recorded weight of a bmi of over 40 in that same year. So when filing the appeal, we did not include that one office visit because she did have other office visits in the same year where she was clearly way above 40.
Have you been denied? Or are you still in the approval process? Who do you have insurance with?
Have you been denied? Or are you still in the approval process? Who do you have insurance with?
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010
Topic: RE: 5 year weight history - BMI under 35
What was the basis for the appeal? Did she have co-morbidities?
Topic: RE: 5 year weight history - BMI under 35
Yes, actually that was the reason my daughter was denied at first, but we appealed and won the appeal. Normally, if your BMI drops below the 'required' BMI during that 5 year history, you will get denied. In our case, we only needed a 2 year history, not 5. We have Aetna insurnace.
Nan
Nan
Nan
HW 300 / SW 280 / CW 138 / GW 140
Hit Goal 4/2/2010