Question:
I have humana hmo had my appeal hearing and it specifiy says..that any treatment

for morbid obesity..and they named all the types of surgery and protiens..werent covered. Does anyone think there is hope I can try to get them to change their mind? They said its becuz of the plan my husbands employeer picked. And he doesn't work for some small company (he's an officer). I have no clue what to do now..if anyone has any advice please feel free to email me ..thanks    — WIBlueyes (posted on June 6, 2001)

June 6, 2001
I have Humana HMO also. It depends on the language in your policy (referred to as the Certificate of Coverage). If it says any treatment for morbid obesity is not covered, then chances are there is nothing you can do. It sounds like you have already appealed the first denial. If you haven't, then I would suggest filing an appeal asap. I say this because you have to file the appeal within a certain amount of time. Your policy should give you details on how to file the appeal. Or call customer service. I have seen some people with this type of exclusion be overturned on appeal so it would be worth a try. Look closely at you policy language because some policies state treatment for morbid obesity is not covered UNLESS MEDICALLY NECESSARY (that's what mine said). If that is the case then you need to submit information to support medical necessity such as being over 100 lbs overweight, comorbidities (hypertension, arthritis, diabetes, etc), a list of medically supervised weight loss programs (anytime you have discussed with any of your doctors about weight loss, prescription weight loss/appetite suppressant drugs, Weight Watchers, etc). And it is true that the employer may have chosen the policy to specifically exclude treatment for morbid obesity with no medical necessity clause. When they chose this type of policy it is because it is available at a lower cost to your employer and you than the policy that allows treatment if medically necessary. I hope this information helps. Good luck to you!
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