OMG! My freakin' insurance!

When I first called Humana they said St. Luke West is 'in network' and bariatric surgery is covered 80/20. Now I am trying to find the certificate of coverage or whatever it is called to see if there are any hoops I have to jump through (like 3 month diet or whatever...) I can not find any info online, so I call Humana and they say my 'group' has the info. So I call my work's HR dept and she has no clue what I am talking about and refers me to the benefits hotline. THEY don't have the info either! So they refered me back to my work's HR and a specific person who says St. Luke is not 'in network'. BUT her comptuer is down and she can't send me any info either! So according to her I have ONE choice of in network doctor. What a load of crap. If it is 60/40 I'm still going with St. Luke & Sonnastine, but WHY do all these people not know what is going on?! VENTING!!!

Sorry to hear you are having ins. issues! When I went thru my insurance approval period and to find out all the stuff I needed I got a run around to so then I contacted my Dr.'s office, and the insurance cordinator said it was best for them to find out whats needed or if there was coverage...so maybe you could get your Dr.'s office to find out about the in/out network issue...I know this isnt much help but it might keep you from losing youre mind!! lol hope things work out!!! Cheryl

Sorry I got to laugh! Another Humana horror story. Almost as bad as what Kat and I went through with Humana. I eventually had to switch insurance's and start again the next year. Last time I looked at Humana physician directory Dr. Tom is listed there as a surgeon and St. Luke is in network.

The official lady just called back and it IS covered @ 80/20 with NO hoops to jump through Dr. Tom's clinic! WHhhoooo Hoooooooooooooo!!!! Melanie g.

Hey Melanie, that's awesome...good luck and keep us posted!!

I have Humana and was assigned an insurance coordinator through my clinic (Georgetown Bariatrics in Georgetown, KY) and she told me exactly what to do. I did what she said and got approved 2 days after she submitted the first time...no problems, no questions. I did have to do a 6 month diet that I am under the impression that Humana still requires. You may want to check on this, as I believe your post said something about a diet.

I too have Humana insurance and had to do a 6-month doctor-supervised diet. Humana required that I lose some but not drop below a BMI of 40. I gained and then lost throughout the 6 months, but my final weight was a little less than my starting weight. Humana accepted that as evidence that I can lose but I have trouble keeping weight off by merely dieting. The insurance coordinator at the Bariatric Center at Georgetown handled all of the communication with Humana. I just did what she told me to do, and I was approved 3 days after she submitted my paperwork. I was very pleased with Humana (although I know not everyone has had a positive experience with them!). I wish you well on your approval process. Kathy

I have Humana as well and I barely meet the BMI 40 requirement. I'm a bit confused on what I have to do during this 6 month diet. If I lose too much, I won't be approved. If I don't lose, then I'm not 'trying'. When did they submit your weight to Humana?....was it AFTER the 6 month diet or does Humana go by the first weigh in?

My Humana is a "special' plan put together specifically by TriHealth (good sam & Bethesda.) That is why Humana does not have our certificates online. So far I have been "told" (for what THAT is worth) that there are no diet requirements (since this is a specialized insurance and not a standard Humana plan...) but time will tell! I did 6 months of weigh****chers so maybe that will count. Guess I won't know until it is submitted. :0P Melanie g.

Just keep trying. Kat had a time with Humana, so I know they love to give people a run for their money. My primary insurance declined it flat out and my second insurance approved it in 48 hours once they got all the paperwork from the office. Go figure@ Sherryl 370/8-23-06 ~ 234/4-1-07 ~ 150/ ?? (come on 150! lol)