So Humana doesn't cover the sleeve?

[ashleey921 62]

Ugh I'm so upset now. Gastric bypass it is then

[Mandybb 183]

Humana Tricare?

[ashleey921 62]

Humana Tricare?

Humana national pos open access through my employer. I was told that today by someone from their customer service. She also told me that instead of the 4 months I was told it's 6 months of an physician assisted diet. [emoji17]

[Diana_in_Philly 1,426]

Do call back and ask for a supervisor. Ask them to send you the specific section of the policy that they are relying on to come to that conclusion. Also, ask your doc's team if they will appeal it. When the doc appeals it, he should ask to speak with another bariatric surgeon to do the review. Generally, if they cover RNY they should cover VSG. The only procedure, right now, I'm aware of that policies that cover bariatrics are avoiding are the balloon. Also, ask that they send the denial to you citing the specific language. Best of luck.

[FormerJock 0]

I have Humana and they approved me for gastric sleeve. Definitely call back, appeal, whatever. It can be done because they are doing it for me.

[ashleey921 62]

Ok thanks I'll call back. But it does seem like everytime I've called I've gotten different information so idk wat to believe. I was even told my plan doesn't cover it at all but I kno that isn't true.
I'm gonna call my surgeons office first.

[orionburn 1,024]

14 minutes ago, ashleey921 said:

Ok thanks I'll call back. But it does seem like everytime I've called I've gotten different information so idk wat to believe. I was even told my plan doesn't cover it at all but I kno that isn't true.
I'm gonna call my surgeons office first.

Your doc's office shouldn't fuss to call on your behalf. I logged into my insurance website and I could never find anything saying they covered the sleeve. It was only the RNY and no offices were close by. I went to a local bariactric clinic and talked to them and they said that they'd had no issues with my insurance covering the sleeve.

You do have to keep in mind that it doesn't just come down to the insurance company itself but rather what's in your policy/coverage through your employer. Not all companies will have a plan that cover WLS, or may have limitations on what it covers. Your doc's office should be able to help you out and get a solid answer.

[hmills653 365]

My surgeon office has an insurance specialist to look into all that. Ask yours if they do also