Question:
Does any of you have Humana Hmo Premiere, Humano PPO, or Humana Choicecare

I have Humana Hmo Premiere and I work for SBC in IL. I was wondering what the criteria for approval is (ie 26 week supervised diet, letter from pcp,etc). I am 5'9 and weigh 277 I am at a 40 BMI. I do not have any co-morbidities, but diabetes runs in my family. I am considering switching to BC/BS, but I would be heart broken if something went wrong with the approval and I were to make a grave mistake by switching insurers. I heard through the grapevine that BC/BS in Il in tightening up on their approvals and making it more difficult to get approved. I work for SBC and there are a number of people having the surgery and I am in the process of asking them the same questions. About 2months ago I had gone to my pcp(thru Humana HMO Premiere)to ask for her approval and she would not back me. I would need a referral from the pcp to start the process. So I am considering switching pcp's. Then an acquaintance of mine told me that with Humana HMO, it is difficult to get approved so she swirched to Humana PPO. I was hoping that there are others out here that can shed some light on the process. I did check teh insurance boards and there were not alot of updated comments. Most comments were a year old. I am looking for people who recently had teh surgery this year. Anyway... if you have any type of Humana Insurance or BC/ BS insurance or if you work for SBC and you have another insurance carrier please help. Thank you all in advance.    — ToriJ (posted on August 18, 2003)


August 18, 2003
I have Humana PPO and was approved 2 weeks after initial paperwork was set in. I've had no trouble with Humana at this point in my WLS journey. I'm now 2 1/2 weeks post-op.
   — Rachel T.

August 18, 2003
I have Humana Choice HMO and they are awesome. I am 340 pounds (BMI 58) with no significant co-morbidities (age 46). I was approved in 24 hours with only a letter from my surgeon and a psych consult. According to the customer service woman I spoke to at Humana (who is having her RNY on August 29th) told me that Humana is extremely WLS friendly - they absolutely believe that WLS is the answer to MO or SMO. Other people insured by Humana have had similar experiences with Humana. Good Luck!!
   — Maridee B.




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