Question:
Is exclusion of obesity surgery in my Humana PPO policy the final word?

I just got back from my appointment with Neweigh. After driving over 500 miles roundtrip, I am very down. I was told on the phone by Neweigh that after talking with Humana, WLS is not excluded in cases of medical necessity. After driving there and sitting in the waiting room for over an hour, the intake worker told me in less than 5 minutes that WLS is an exclusion with my policy. Is there any hope? I have Humana PPO. I called the precertification nurse myself and she told me that it is a covered benefit if it is medically necessary. But, in my coverage booklet it is excluded. Why am I getting the run around? What are my options? Neweigh was no help at all.    — Brenda B. (posted on October 14, 1999)

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