Insurance question- Humana PPO

Hi there! I've been researching WLS for about 3 years, and finally decided that it is definatley  something I want to pursue. I watched a friend of mine go through it and have learned about foamies and dumping and all that lovely stuff I signed up to go to the next information session at St. Joe for Drs Greenlee and Steiner, but I just re-read my insurance policy and under "Limitations and Exclusions" it says: • Any treatment, including but not limited to surgical procedures: - For obesity, whi*****ludes morbid obesity; or - For obesity, whi*****ludes morbid obesity, for the purpose of treating a sickness or bodily injury caused by, complicated by, or exacerbated by the obesity. Anyone else had this on their policy? I am so deflated thinking about not having it covered by insurance. Thanks in advance- I'm inspired and helped by everyone here! - Emily

i am state employee, have humana ppo...i contacted insurance co and asked about the conditions.. when i attended the norton bariatric center's seminar.. we were given questionaire to complete and return. one of the forms had series of questions to ask your insurance co.... humana stipulated a bmi at certain level and co-morbidity systems... they also requested information to verify that you have tried to lose weight for 6 mos straight, etc.,, one method to verify this is monthly  visits, for 6 mos straight, to your pcp to track your weight loss , etc... i started monthly visits in 02/08... i don't know if it helped or not...but i made copies of my weight loss records from w----t   w----rs for the last several  yrs. ( i had attended off/on  6-8 mos straight).. i am to see surgeon in 2 wks to set surgery date... received notice approx 2-3 wks ago, surgery approved..... documentation of previous weight loss attempts can only help... i am sure other members with this message board can also assist., as there are several that have humana..."nurse navigators" at norton bariatric center were very helpful in answering my questions... good luck.... 

Cathy, Did you say there will be a total of 4 or 5 weeks between insurance approval and your second meeting with the surgeon? I'm thinking you have the same surgeon(Dr Tanner) as I do. Gosh , the wait is getting longer isn't it?

annie, so sorry for confusion... what i was  trying to say was that insurance approved the surgery 2-3 wks ago... i have appt with dr tanner 07/11/08 to set surgery date... august would have been my 6th and final month to visit dr.. i plan on keeping pcp appt july and august to keep the insurance requirements.. BUT  from the notices i have received, the surgery is approved...... my mind has one thing in it and by the time my fingers type it is on to another topic ( my thinking/typing is screwed up sometimes) ...again sorry for misleading you.... have you met with dr tanner for your first visit.?

Thank you for the clarification. Yes, I met Dr Tanner the last of May. Unfortuately one of the offices(PCP or Surg) failed to send in documentation of morbid obesity for 5 years leading to a denial from my insurance. Last week I stood in my PCP office and watched them fax the documentation to UnitedHealthcare. I understand the insurance has 15 days to review the appeal. I really can't imagine them not approving it at this point. It sure looks like you are getting close to your surgery, good luck and keep us posted on your progress to and through surgery.  Waiting not so patiently

I think the waiting is the longest when we can't to see any progress... prayers with you for appeal...good luck--keep smiling

I believe a lot of the policies have exclusions in them like yours;  This possibly could be to your benefit.  MANY of the insurance policies are "covering" WLS now and will pay varying amounts that end up leaving you with lots more our of pocket. (example: some will pay 50%, some will pay up to a max of $10k,  etc.... these all leave you with an out of pocket of $10-$15k or more if you have complications.)  With the exclusion you can still submit for approval and then appeal as needed.  Then if they approve you would be covered as you would for anything else.

Wendy handles the insurance part at Dr Greenlee office and she will give you a paper to give to your family doctor to sign and you fill it out and I faxed it back to her and got approved in two or three days and had the surgery the following week! You do have to go to your family doctor for 6 months... I have Humana PPO and didn't have any problems... Dr Greenlee was my doctor and he was great! Good luck!

I have humana and i jumped through their hoops for six months. i did everything exactly like they stated with a bmi of 42 and comorbid conditions of hypertension, insulin resistance, stress incont., and sleep apnea.  all was submitted on tuesday and got approved on wendsday. 

Thanks! I spoke to Wendy and she said the only way to find out is to try, so that's what we're going to do! The session is on the 14th, and I really can't wait. I even spoke to my boss about it and she said the company would support me however needed (time off, etc) so I am just ready to proceed and see how it goes!