Guest guest Posted February 12, 2004 Report Share Posted February 12, 2004 Is Humana the same as Tricare? Candi Humana Insurance! I heard today that effective June 1, 2004 Humana will NOT be covering any " morbid obesity " surgical claims. This means that Humana will not cover gastric bypass surgeries of any sort. If you are contemplating this surgery and have Humana I suggest you contact your Plan Administrator ASAP. This info came to me from my Plan Administrator who knows I am waiting for my date. Karyl ---------------------------------------------------------------------------- -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 12, 2004 Report Share Posted February 12, 2004 Is Humana the same as Tricare? Candi Humana Insurance! I heard today that effective June 1, 2004 Humana will NOT be covering any " morbid obesity " surgical claims. This means that Humana will not cover gastric bypass surgeries of any sort. If you are contemplating this surgery and have Humana I suggest you contact your Plan Administrator ASAP. This info came to me from my Plan Administrator who knows I am waiting for my date. Karyl ---------------------------------------------------------------------------- -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2004 Report Share Posted February 16, 2004 I am not surprised by this move by Humana. They have never been very WLS-friendly...I had Humana when I first tried to get my surgery. It was thru a new company policy (a different company had just purchased my employer, and the new insurance was Humana). All the info I had stated the procedure was covered. I went thru initial consultations no problem. Then, after two months of the process, I was informed by Humana the WLS was NOT covered after all. Despite the fact I was able to provide all the documentation I had showing my group policy numbers and that it was supposedly covered, they insisted on appeal it was a direct exclusion in my policy. They first tried to say I was sent the wrong policy info, then changed their story to say it was part of the contract that employees of my company would still be covered under the provisions of the old insurance policy for 6 months despite the fact it was a different insurance provider altogether. It was a load of BS. Because I had some serious comorbidities, I couldn't fight them like I should. I had to have the surgery. One thing, tho...I had a lot of complications that required hospitalization for 3 months. Because I was initially discharged 4 days after the surgery then returned two days later, it was shown as a separate hospital stay and was billed as such...not as follow-up to WLS. They wound up covering me for a whole lot more money than if they had covered the surgery (about $180,000 in fact!) Steve G. open RNY 5/6/02 Dr. Mark Gibbs 605/318/299 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2004 Report Share Posted February 16, 2004 I am not surprised by this move by Humana. They have never been very WLS-friendly...I had Humana when I first tried to get my surgery. It was thru a new company policy (a different company had just purchased my employer, and the new insurance was Humana). All the info I had stated the procedure was covered. I went thru initial consultations no problem. Then, after two months of the process, I was informed by Humana the WLS was NOT covered after all. Despite the fact I was able to provide all the documentation I had showing my group policy numbers and that it was supposedly covered, they insisted on appeal it was a direct exclusion in my policy. They first tried to say I was sent the wrong policy info, then changed their story to say it was part of the contract that employees of my company would still be covered under the provisions of the old insurance policy for 6 months despite the fact it was a different insurance provider altogether. It was a load of BS. Because I had some serious comorbidities, I couldn't fight them like I should. I had to have the surgery. One thing, tho...I had a lot of complications that required hospitalization for 3 months. Because I was initially discharged 4 days after the surgery then returned two days later, it was shown as a separate hospital stay and was billed as such...not as follow-up to WLS. They wound up covering me for a whole lot more money than if they had covered the surgery (about $180,000 in fact!) Steve G. open RNY 5/6/02 Dr. Mark Gibbs 605/318/299 Quote Link to comment Share on other sites More sharing options...
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