Humana PPO

[austex 0]

I am wondering if anyone has used HUMANA PPO as their insurance and had this procedure approved or denied?? IF so how long did this take?? I am going through my 5th month of my 6 month weight loss program with them , I am also having to meet with a psychologist on Monday. Any one have any ideas what they will be asking me?? Any info will help!!

TO all on this web site good luck !!! :Banane37:

[zukagirl22 1]

hey there! i'm in san antonio tx :Banane37: i have humana ppo and was approved!!!! i just had surgery aug 11th :sleep2: As far as for the psych consult it's just kinda like common sense. don't sound like you have any psych probs or like you have unreal expectations from this surgery and that this is not a quick fix but more a tool to be used along with a healthy diet and exersize. good luck and feel free to ask me any questions :crying:

[austex 0]

Hey there wow thanks for the info, so did u have to do the 6 month thing too?? How long after all ur paper work was turned in did it take them to approve u??? thanks for the tip on the psych evaluation.

So how are u feeling so far?? are u sore, sick to ur stomach?? any nausea, vomiting?? How long before u can eat or drink anything??

did they recommend what type of Protein Shake to buy??

it is nice to know u, please keep in touch and good luck on ur new life.

[tprejean 0]

I am also with Humana PPO in Louisiana and was just told by Rep that "obesity surgery" specifically excluded and has only seen one case approved in last 4 years. Just wondering how you managed to get approved. Would love to know the secret. New to the idea of banding and have informational seminar scheduled for Aug 25th but don't want to go if insurance is going to deny...HELP!!

[austex 0]

I have Humana PPO but it depends on what company has it mine is Humana Dell PPO, my husband works for Dell so I am covered through him. What company is ur insurance though?? Mine does cover 1 bariatric surgery per life time this much I do know... I first went to a True Results seminar and found out later that the were out of network with my insurance so I went and transfered all my records to Southwest Bariatrics here in Austin, Texas so far I was approved only I had to do the 6 month weight loss program and all the other stuff that goes along with it then once all that gets submitted I will see what they will say?? I pray they will approve it in the end.

take care and good luck keep in touch!!

[zukagirl22 1]

for my insurance i had a choice between a 6 month diet or a 3 month diet plus exersice(sp?). the 3 month one option meant i had to pay a littlemore because i had to go see 2 seperate people but it was worth it to speed things up. After my paperwork was turned in i called the insurance company to see if i was approved and it only took 3 days from when they received the papers. got the official letter about 7 days from when they received the paper work. As far as does it hurt i am gonna copy a post i meade today about just that :

well i had my surgery on aug 11th and here i am. i did it! but let me tell you my experience because all i read about in this site was how painless and drug free this postop time is. now don't get me wrong i don't regret my getting the band at all. :wub:for some reason i just remember reading about how some people only needed their pain meds once. Not me! When i first woke up was the worst part of it. I wasin pain and i could hardly move and yet they were asking me to roll around for an x-ray! :mad2:the sholder pain is the worst. i think i remember people saying it's b/c of the port but whatever the reason my left side hurts and makes it hard for me to breathe. now as long as i take my pain meds i can knock out and just sleep through the pain. Now i hope not to scare anyone and again i don't regret it. just telling it like it is. :sleep2: on a better note i have been drinking Water and beef broth with no probs of nausea. juat a little nausea due to the anesthesia first day post op.

again i hope i don't scare anyone:blushing: but maybe for those who are thinking they might be back to normal 2 days out.... well just don't plan on it because we are all different.

this might link you to some of the responses if not look it up it's title "ouch!!!! it dies hurt"

http://www.lapbandtalk.com/f183/ouch-does-hurt-72653/#post956437

good luck and keep any questions u have coming :Banane37:

[austex 0]

hey I am sorry to hear u are feeling bad but one day maybe u can help me too get through this, I am sure it is horrible and u are miserable that is one of my greatest fears. I just look at it like that in the end it will all be worth it.

How long after were u given something to drink?? How long did u stay there at facility?? What are u drinking now to stay hydrated and how long do u just do liquids? ?

How are ur incisions feeling?? Any relief with the gas??

Do u have help at home now since u got home ?/ from the family etc?? do u work?? if so when do u return?? Do u have any children?? I hope u have a good night and thanks for sharing ur experience with so many of us getting ready to take the same journey u have hose too.

Keep in touch, Becky

[JamieNP 20]

Tprejean,

I also have Humana PPO with an exclusion written in the policy for WLS. They have paid for all of the pre op requirements (the EGD, PSY eval, lab work) but will not pay for surgery. Thank goodness I have a secondary insurance! I am sure I would try to fight it if I had to. I think you have to go through your employer to try to get the exclusion changed, since they are the ones that specifically had it placed there. You could talk to obesity law.

[zukagirl22 1]

oh yeah well i can say this for sure that the pain is much better day by day :Banane37:. Well as far as the drinking part i was given ice chips and Water about 2 hours after surgery. (the nurse offered me a diet soda but as far as i know we aren't supposed to have anything carbonated so i just didn;t drink it). the water stayed down with no feelings of nausea. I only got a lil nausea when i stood up to walk up and down the hall which was about 3 1/2 hours post op. my surgery was schedualed for 8am and i was out by 2:30 ish. Now i am drinking water. and i mix in some of that kelogs potein water to get some Protein. My insicions are doing well except for 1 that is well sorry if this is TMI but it's ight under mt breast and it kinda is rubbing on it. I just put a paper towel on top of it to prevent running. no gas problems but i been using the gas-x strips just in case. i take bout 2 a day. as far as home i live with my parents but really i can do everything for myself. i showered the next day after surgery but immediatly took something for pain. i do work but i have 2 weeks off before i go back to work or school :sleep2: oh yeah andi don't have any children but if i did i wouldn't be able to care for them much. i have pretty much just beenlaying around on the couch for the last 2 days. oh and also it is painful to sleep laying down so i have been sleeping on the couch sitting up. i have heard people say it is very comfertable to sleep in a recliner.

[austex 0]

My insurance doesnt exclude the WLS it will allow only one per life time, so I am hoping to take advantage of that ..

thanks for the info and take care !!

Good luck

Becky

[tprejean 0]

Thx so much for the info, but I will probably have 2 wait and hope that my company will allow. If u can believe it, I work for the state of Louisiana as I work for the school board. One would think that they would see the importance of this type of surgery and embrace it! NOT!!! Well, I won't give up and hopefully things will change. I will keep you posted, and be blessed on your journey. Tonya

[austex 0]

I wish u lots of luck I am sure ur HUMANA PPO is very different from mine that is sad. Dont give up and see what u can find out??

Keep me posted as to ur progress with this and good luck on ur long journey as well.

[nooch 0]

Hi Austex! I am on my 5th month of my 6 month weight loss program. And guess what I live in Austin and work for Dell and I'm going through Southwest Bariatric. We have a lot in common! I'm meeting with my surgeon next Weds. Aug 20th. I can't wait. I'm so thrilled and can't wait to get my life back. Let's try to connect.

[g00dbyefat 0]

Hi there...I'm in Austin and have Humana PPO (thru DELL). I have been going to True Results and just got approved last month. It is covered under PPO but I have to go to SAN ANTONIO (NIX center for the surgery) I will be banded on 8/25 (only 11 days away)....getting nervous. I am scheduled w/ Dr. Carcamo and hear he's a GREAT surgeon. Lots of good things said about him in this and other forums.

I had to do:

• 6 months supervised weight loss program
  
• 2 nutrition consults
  
• psych consult
  
• Ekg (which was abnormal) so I had to do...
  
• Cardiac Clearance (involved nuclear stress test and Cardiac Cath surgery)
  
• sleep Study
  
• 2 sets of bloodwork
  

When I first started it seemed that it was impossible, but w/ 6 months to complete wasn't too bad. I wasn't happy about the cardio DR, but my BMI was 50 so they required it. If you're under that you should get to avoid it. It was a lot of steps, but I got my approval in 3-4 days and had NO HASSLES! For me it was worth it, they're gonna pay for the $15,000+ procedure so I'm happy!

Edited August 15, 2008 by g00dbyefat

[austex 0]

nooch ,

I sent u a message u will be excited to hear about , humana dell has changed their requirements as of august 1, 2008 u only have to be 100 lbs overweight to have the procedure and u dont have to go through the whole 6 months thing right now. I am on my way to the doc to complete the rest of my things to schedule my surgery contact me if u need more info.