Humana ~ 36 BMI ~ denial ~ WHAT NEXT?

[gatzpup 0]

A little summary of how I got here: March 07 I went to an information seminar. I filled out forms, had required testing done, saw lap band doctor in August 07, and after much frustration with the office staff (took them forever to get my paperwork to insurance), I finally got my denial yesterday, 2/1/08!

I have Humana insurance. On the phone, I was told by the dr. office that I was under 40 BMI, and my only problem was hypertension, which is controlled by meds. I also do not have a doctor-supervised weight loss (which I was told early on this was not necessary). I have tried many different programs over the years, but nothing that my doctor has notes on.

My hypertension IS controlled by meds, however my dosage has been doubled since I started it and realistically, I'd like to be able to quit taking it! I also have high cholesterol and am beginning to feel pain in my feet and knees. This stuff is only gonna get worse. I honestly feel like having this surgery will cost insurance less in the long run.

I will be getting a denial letter in the mail and it will describe the appeals process. My PCP is a personal friend and has been very helpful during this process, so I'm sure that will continue with the appeals process. Do any of you have any advice? It's been a long frustrating experience, but I'm not going to give up. During this year of waiting, I've even gained more little weight!

Any advice will be appreciated.

Thanks!

[Alfie 58]

Very frustrating, you would think that the surgeons office would know exactly what each insurance company requires since they work with them on a daily basis. I ran into an issue with mine as well which got resolved, but was thinking why did the girl in the office, that deals with Aetna on a daily basis even send it in if something was missing. She also told me that she had 3 other denials on her desk for the same reason...HELLOOOOO

[Luu2008 2]

I have no advice. Just wishing you the best on your appeal. It certainly sounds as if you meet the qualifications for the surgery. Good luck.