Question:
Will Medicaid insurance through the state approve my surgery if i have Humana?

I have Humana insurance through my employer, but i used IL Med. as my insurance to have the surgery because i thought that they would be faster to approve and i really did not want any one at my job to find out that i am having the WLS per say. Not that i am ashamed but I believe if you don't tell your business people wont be in your business. But i recently found out that IL Med. knows that i have Humana and from what i was told they will not pay unless it has gone through Humana first. Is there a way that i can only use IL Med. because i have a doctor that i have seen for my initial visit that excepts this insurance. Open enrollment for Humana at my employer is 9-1-00, i was thinking of switching to a PPO during this time, but i wondering now should i just drop this insurance and only try through IL Med. HELP I am very confused and don't know what to do.    — theresa B. (posted on August 18, 2000)

August 18, 2000
I have Humana HMO, in Wisconsin. There is another person I have been writing who also has Humana, PPO. She had surgery thru them. 1st-On any Medicaid you must go thru your first insurance 1st. So you must do everything you can to get this approved thru them, but at the same time you can be working thru your 2nd because if the first will not cover the Medicaid will. Humana has a web site. Humana does cover this for certain criteria- morbidly obese, bmi>40 3 yrs or for persons >bmi 35 with co-morbidities and other criteria. The Humana web site is complex, but one day I went into the provider side. Looking under the conditions needing preauthorization. There I found this wonderful information. They also cover tummy tucks post if you meet certain criteria. I called Humana cust service and was told wrong info about my daughters pregnancy coverage. Was I mad, I called the state to check on it because it just plain sounded wrong when she said it. Customer service obviously needs more training at this company. They are not trained in all the complexities of different conditions and situations so give an answer albeit the wrong one. Obesity is not covered, correct, but the surgery sure is, for other reasons.
   — JennyLynn A.