Humana denial

[joyNky645 0]

Today I received my first denial for lap band surgery. While I was told by friends to expect a denial the first time, I am disappointed. I thought I did everything correct.

I am now going to appeal, but first just wondering what others experience has been with appeal and humana.

The denial states "available documentation does not indicate that this patient has a primary care physician who has followed her pre-operatively, agrees that she should have the procedure performed, and will follow her post-operatively after procedure is performed."

This to me sounds like maybe some information was not submitted to them. I did the 6 month supervised diet, and have the bariatric referral form from my primary care doctor.

Any comments? Thanks.

[honk 780]

Call the insurance company and ask if they received the documentation of your supervised diet. Sounds like they didn't. Call your doctor's office and ask what documentation was sent to the insurance company.

[Boo_68 6]

With Humana you have to have all documents sent from your PCP also (showing your 6 months) they also want to know that you have a PCP on board after surgery, not just your Bariatric Surgeon...sounds like all the paperwork wasnt sent. Hopefully you can get this corrected soon. Best Wishes

[nancypan 0]

I have Humana and it was smooth sailing for me and my BMI is only 36 but I have sleep apnea and high blood pressure. I was approved within 3 business days....my surgeons office says that Humana is very easy to get approved I would say to call Humana's bariatric line and ask what you need for approval. They are extremely nice and seem to be willing to help. My surgery is scheduled for december 1st...Good luck to you!!!