Question:
Has anyone with Humana ppo and an exclusion for the surgery

been ablt to get approval for the surgery with it being medically necessary ? If so , what did you need to produce or prove ? Any chance that Tanya Jones of Houston might be able to help with this , I see from another question she answered , that she is a pre-cert nurse and there was no email address to contact her at ....... thanks all    — patti G. (posted on May 16, 2003)

May 18, 2003
I have Choice Care/Humana. It has an exclusion stating that on VGB can be done, but when I called their office to ask about it, they said that all Gastric Bypass Surgeries are approve at this time if they are deemed medically necessary. Do you have reflux, sleep apnea, heart condition, etc? Any of these can help you be considered medically necessary. If you'd like, you can email me personally. I didn't have to do anything to prove it, my surgeon filled out all the paperwork and sent it to my insurance. I was approved before I even knew the paperwork was filled out...even before I had found out that I had sleep apnea (all the info they gave them, was my heart palpitations and reflux...don't forget my BMI...it was 43).
   — Renee B.