Humana PPO and CoreSource PPO

Liz0315
on 2/22/07 3:49 pm - IL
Anybody have any info on Humana PPO and CoreSource PPO? Like what the require and who is a canadate to them? Anybody know if they cover the surgery or how to get them to? I would like a laproscopic RNY done. Let me know thanks
sandy7761
on 2/22/07 10:07 pm - Mokena, IL
I have Humana PPO, and they covered my surgery performed at UIC by Dr Vitello in November 06. I had a BMI of 37, but co morbids of diabetes, uncontrolled by insulin, skin rashes, joint pain, depression, and insomnia. My Dr.(surgeon) applied for preapproval, they asked for a letter from my PCP stating that he had followed me in supervised weight loss attempts, (he just hand wrote a note which we faxed in). It took 6 days from application to approval. The one hitch I have had is that you have to call for preapproval of EVERYTHING. They approved my surgery, but denied payment of the presugical bloodwork, chest xray and ekg because we did not make a SEPERATE phone call for approval of that, although normally you don't need preapproval for lab work and xray, since it had to do with "obesity" you have to call. I have to call for preapproval of EVERY follow up visit with my surgeon. They are sticky with this stuff, trying to get out of paying any little thing they can, but if you follow the rules to the T, you won't have any trouble. I had my surgery less than 6 weeks after my initial consult with the surgeon! I did not have to repeat a supervised diet as I had done that with my PCP over the years. I went to the surgeon with a list of all the weight loss attempts I had made in the past 15 years, and he was satisfied with that. Good Luck Sandy
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