Received second denial from Humana

Busy · November 10, 2006

Not wearing my happy face today. After having a wonderful day off, 76 degrees outside, took my 93 year old aunt on a drive in the country, went down and got a pedicure, picked out a Christmas present for my hubby, I came home and found a denial letter from Humana. They said the denial was due to me not having life-threatening co-morbidities. I'm thinking, "no, not yet, but I am 47 years old and get rounder every year, I am attempting to prevent from having life threatening problems, hence the weight loss surgery!!" I am upset and need to know what the next step is. By Sunday I will be good and mad and ready to do what I need to do. My question is what do I need to do??:help: :help:

Carlene · November 11, 2006

I notice your ticker says "73 pounds to go". Does your BMI have anything to do with the denial?

Most insurance will not pay if you are under 40 BMI unless you have multiple, serious co-morbidities (heart disease, Diabetes, severe sleep apnea, COPD, etc).

I would say you have only two choices:

Gain enough weight to qualify

Self pay

Busy · November 11, 2006

Carlene,

I would be content with 73 lbs and my BMI is 41. The letter my pcp sent said I have high cholesterol, osteoarthritis, high blood pressure and acid reflex. I know right now none of these things are that serious...yet.

Carlene · November 11, 2006

Carlene,
I would be content with 73 lbs and my BMI is 41. The letter my pcp sent said I have high cholesterol, osteoarthritis, high blood pressure and acid reflex. I know right now none of these things are that serious...yet.

Unfortunately, insurance companies get around that by saying you can control BP, reflux, and cholesterol with meds. Do they allow more than 2 appeals? I would go as high as I could with their appeal process. After that, your options are pretty much limited to self pay.:think