Any Luck With Humana?

Ok, so I use to have Blue Cross Blue Shield Of IL and last October they denied me due to needing 12 months of supervised attempt at weight loss. I have been doing my 12 months but my husaband changed jobs so now we have Humana PPO. I hear that they only require 6 months so I have been getting all my ducks in a row and my Doctors office is sending all the notes and paper work to Humana. I am so excited but also scared to death. I just hope they approve me. I was wondering if anyone has had any luck with Humana or if I made a huge mistake switching insurances. I dont know much at all about Humana or how hard or easy it is to get approved so any feed back from you all would be nice. Thanks Sherri

Hi Sherri I had Humana choicecare at the time of my surgery 12-28-04. Dr Shina was my surgeon. The girls in his office took care of everything!! I did not have ANY problems with Humana what so ever. I think everything will be fine. Have you contacted your Dr's office? WLS surgeons/office help deal with the insurance so much they know what is needed/required to get you approved and ready to start a new life. Blessings Tonya

Hi.. I actually work for Humana and it all depends on your employers plans... Humana often just implements and processes what your employer has set up for the company. Really depends on the type of plan. I know myself having Humana I got approved no problem.. no issues.. then my friend who has Humana was denied because her employer had a "clause" in the policy. Do you know what type of you have?

I have Humana Choice Care PPO. I tried to call the and see if the surgery was covered and they told me they didnt cover obesity surgery. I ask him well what if it is a medical Necessity and he told me then yes they do cover it but they are not sure about my policy. I just got the Humana policy on 8/8/05 and they are telling me because it is still so new that they can not tell me what my policy covers. My husband works at Diesel Republic and I told the man from Humana that but he said that because my policy is so new that he cant access my coverage and benifits yet. Is this right? I guess I will find out someday soon hopefully. I talked to the HR person at Republic Diesel and she dont even know if it is covered or an exclusion. I just dont know who else to talk to. You would think someone at Humana would know what is covered under my policy or even the HR person at Diesel Republic BUT NO ONE HAS ANY IDEAL. I guess I will wait and see. Thanks for the info

I also work at Humana you can find the information out yourself if you register on Humana.com you can view your coverage certificate and you wqant to pay particular attention to the "exclusions" section. If there is nothing in there about treatment for weight loss, gastric bypass, treatment for mobid obesity, or obesity surgery, you should be fine. I can't guarantee that without seeing your actual cert. If there is no written exclusion, then it should be covered based on medical necessity. Please remember, the employer decides what they will and will not cover, so if there is an exclusion it is the employers doing not the insurance company. Basically, insurance companies build plans specifically for employers. Employers decide what they want to cover and what they dont want to cover, unfortunalty more and more employers are choosing not to cover WLS of anykind. It is a shame, but it is their choice..If there is an exclusion, you can always go to the employer with your documentation and see if they will waive the exclusion for you. Hope this helps, Sherri

Thanks so much with the info! I have registered on line and I have tried every hour or so to look at my coverage and benefits but it keeps popping up A window that says that my policy is in process and if I have any questions on benefits I need to contact the number located on the back of my card. I call Humana and they tell me they cant access my records yet because my policy is to new. My policy started on 8/8/05 so I dont understand why it is taking so long or who I need to talk to in order to figure this out. I am so confused at this point. The HR person doesnt know, Humana cant find out yet, and my policy is to new to have access to befefits and coverage online. WOW. So I guess I will just wait some more. Thank You Sherri