Question:
Seeking Others Who Have Dealt With Humana PPO

Anyone have any problems with Humana PPO?    — Lisa F. (posted on June 22, 2003)

June 22, 2003
hi lisa - i have humana ppo . but my policy also has an exclusion towards surgery . it says " any surgical procedure to reduce obesity " , but i am still trying to get an approval from them . i have gone for a weigh in and am waiting for the surgeons office to put in the request to ins. . they say it might be two - three weeks before they do this ( back logged ) , so far it has been over one week . who knows with humana , do you have any type of exclusion ? what does your policy say towards this ? i am ready to fight if need be , good luck and i hope to hear back from you ...........
   — patti G.

June 22, 2003
WLS is a covered according to my hand book...they say it must be medically necessary...but whats that mean?....I have alot of back pain....my BMI is 49...and have borderline high blood pressure....everything will get sent in to the insurance co. sometime this coming week...I'm soooo stressed out I'll be denied....I really hope I get an answer from them soon.
   — Lisa F.

June 22, 2003
I have Humana PPO without the obesity exclusion, and I was approved promptly with the letter of medical necessity from my surgeon. I called Humana a coupe of times to check on the status of my approval; they were always very polite and happy to check on it for me. Good luck! :)
   — jellybean0605

June 22, 2003
I had humana ppo and once I completed all of my tests, (sleep apnea, the pysch screening, lab tests) I was approved quite fast.
   — pking35

June 23, 2003
Hi! I have this insurance and do not have an exclusion, it just states it must be medically necessary. I had no problems, I had a BMI of 40 and general aches and pains, and of course the dreams of being able to run around and not lose my breather. I was approved in about a week. If this is something you really want to do and have researched all the good, the bad and the ugly aspects of it, then i would say to go for it. What do you have to lose? Just weight.. if your approved! :) If not approved, then yes you'd be disappointed but you haven't moved a step backwards per se. Your just standing still... I was highly surprised that I was approved, I am young (was 20,turning 21 at the time)and basically no co-morbids and a BMI barely at 40. But it seemed like not a problem. One thing I would like to ask any other posters though- **anyone able to get a tummy tuck through Humana??** Thats my next hopeful surgery... Good luck to you!! Post Op almost 1yr, -107 lbs at 155 and sizes 9-11
   — Sunny4x4chick

June 23, 2003
I had my surgery in March of 2002 and I had Humana PPO. I didn't require anything and they approved me in no time at all. If you have any questions I can try and help you. Started at 275 pounds and am down to 120 pounds. Size 28 to 4. Best of luck to you.
   — Tammy B.

November 5, 2003
I have Humana PPO w/exclusion "no surgry to reduce obestiy" I have spoken with them on several occasions and have got mixed answers. One Customer Service Rep told me that is would be covered with medical necessity, another told me that the exclusion was air tight! I called the PreCert# on the front of my card and spoke with a women in claims and she told me that they recognize the difference in obesity and morbid obesity. It was the first time I was ever glad to have morbid obesity since I found out that I was. I am going for it...the worst that they can say is no. The best I can pray for is a new life. I for one now what it is like to have your fate rest in the hands of someone that doesn't even know you. It can be scary but the only thing you have to lose is pounds! Thxs.
   — The-Irish-Lassie

November 5, 2003
I have Humana PPO and was just approved about a month ago. I was told at first by a rep Humana no longer covered this surgery but I called the pre-authorization dept. and was told if my drs. said it was medically necessary they would approve it and they did within 1 week of getting my doctor's letter stating it was necessary and listing my various co-morbities. Good luck. Hope they approve you as well.
   — Carlene B.