HELP FELLOW WIites.. Wondering if anyone has used Humana Insurance??

88Shelly88 · January 17, 2008

So I called my insurance company again and they told me that the procedure would need to be deemed medically necessary by my doctor. Has anyone had any expereince with HUMANA? Do they make you try other things first? To be honest with you besides a family history (mom, aunt, and grandmother being obese plus a dad with high colestrol) I have not had any other medical problems. I am just now starting to have sleep apnea (I think) and also knee problems. I am only 26 years old. Based on what I have found being 5'1" and 230 pounds I am MORBIDLY Obese. Do you think that I can qualify with just that? Is it hard for the doctor to convince the insurance co? I have my 2 hour consult coming up soon. :wink2:) I feel that I need this as I have tried everything to loose and just can not. :lol: (:pray2:

vessa · January 18, 2008

From what i know, almost every insurance company says, "must be medicallly necessary..." THAT"S GOOD!!! It's not like they would say, "yes yes go now! Here's the money!" Basically, they are saying, you have to have, in a doctor's written opinion,sent to the insurance company, that you should have the operation, based on the necessary to save your live, or improve it dramaticallly. I had trouble with this too in beginning, I in't have regular doctor, so I just went to some random family doctor. Big mistake, the woman obviously had no concept beyon herself, told me(after knowing me a whole 5 minutes, and interupting me too, that "I needed to drink less soda (i clearly stated to her I did not)and maybe work out at a fun place, like curves". ERRRR I could have thrown her out the window! (I really could have too, she was like 95 pounds!) It sounds like you have gone to a good place, that you have a consult, in my opinion, the only doctors who can really understand obesity are those who specialize in it (and perhaps a select few). If you are going to a place or octor that specializes in it, if you need it, you will be fine. I am 26 too, but was over 300 lbs, but 5'6", but also no real problems, yet. If you meet the criteria, sometimes just the BMI is enough (usually, i would suspect). Also, the doctor isn't going to find you meically necessary if you have issues that are more important that losing weight (i.e.mental things, a lot of us have to get psych evaluations first, it is mentally tough to go thru life the first year or so after band, lots of big changes, so you have to be mentally fit.) Also, things like if you can't make it thru surgery because of other medical reasons, heart stuff I would assume. I'm sorry this is long-winded, I've been where you are, it is a heavy worrisome place, wanting it so bad, being afraid of being denied. oh, man, I had weeks of no sleep! An everything went swimmingly, in fact, the doctor's usually thing was to do all the paperwork themselves, I just got the approval, in less than two weeks, over the holiday. It was so awesome! don't be worried, "must be medically necessary" is gold, alot of folks, get the "no way, jose" right in there insurance paperwork. This is based on what i've experienced and from reading a lot of other's posts too. My husband gets Humana in February, so your post gives me hope too, you hear alot of chatter here, things that scare you and make you doubt (i'm in a situation of having to find a new fill doctor in wisconsin because of moving here) so i hope i have given you a little bit of hope, as you have given me.

vessa · January 18, 2008

P.s. I was SUPER MORBIDLY OBESE, what a title, huh?

oh, and just tell them the long list of stuff you've already tried (im sure you have we all have) diets you've gone on, exercise programs, (i was terrified they'd ask for reciepts, NAW!)

Also, knowledge of stuff, nutrition wise and things of health seem to show my doctor I knew what I was talking about, and wanted it bad enough, and could act accordingly with band, but couldn't get there without help).

88Shelly88 · January 18, 2008

Thanks so much Vessa for all of your great input. ) You give me hope and are helping keeping me motivated to under go this long journey!! :huh2:) Where will you be living in WI? I am going to see Dr. Jospeh Regan and he is with Columbia St.Mary's hospital. He is also the head of the surgeon team and looks like he has tons of band experience. I have my 2 hour consult in two weeks and I can not wait. How has the diet been? Is it hard to adjust to?

sfeiner · January 19, 2008

Hi girls. So glad to see you on the Wi board. I live near Wi Dells. Where do you live?

vessa · January 22, 2008

Waupaca wi

windyacres_2000 · April 20, 2008

I have Humana and am working this through. You can go to this .pdf document and it gives the company guidelines. I had a heck of a time finding this information. Calling Humana was worthless, I'd wait on the phone for 45 minutes and get a different answer every time. You have to make sure that your policy allows the surgery, though.

http://apps.humana.com/tad/tad_new/returnContent.asp?mime=application/pdf&id=5425&issue=132

writegirl · August 2, 2009

Humana covered my surgery two years ago. I had to do six months of medically supervised diet and exercise, as well as all the standard stuff(doctor's letter of necessity, co-morbidities). I called Humana a few months ago because I thought I might be facing a slippage and they gave me a number for their bariatric department -- 866-486-5295, 8:30 a.m. to 5 p.m. Eastern time.

Edited August 2, 2009 by writegirl