Humana Gold Plus HMO Insurance and Gastric Surgery

I thought I would share the information on here because it took so long to get to the right person. I hope this information is Helpful for those who are beginning their weight loss Journey.   I do not have any other insurance information, nor do I have Out of Network information. Of course the best thing is to call your provider, but if you are like me, researching this after hours, and would like BASIC INFO...here ya go.  HUMANA GOLD PLUS HMO Insurance ONLY....if you have another provider...disregard.

Procedure codes: 43644, 43775 which is the Gastric Sleeve and the RNY Surgeries.

 Criteria to be met:

• Must be age 18 or older
• BMI of 40 or above
• If BMI is 35-39 must have a Co-Morbidity (Something caused by overweight, Hypertension, Bone problems, Diabetes etc)
• During the last 12 months PRIOR to Pre-approval, must have seen a Dietitian or Weight-loss Doctor for 3 months.
• Psychological Evaluation ( They need to know you are being realistic about outcome)
• Failure to achieve or maintain weight loss on a nonsurgical diet.

That info only applies to you and the location (city, state etc) you are in. 

In different state or different city - the condition for this  insurance can be very different. 

Good investigation.  Anyone should be able to call their insurer and get their info. 

That is the information that people need to get from their insurance representative.  The weight requirements are pretty universal, the co-pays and pre-op requirements will vary by policy.

I had a 2,000 co-pay and paid out of pocket the full cost for dietary and psychologist appointments.

I was also 39 BMI with diabetes, so had to lose weight but not get below 35 BMI during six months of supervised dieting.    

From what I was told was that it was for HUMANA GOLD PLUS HMO Members.  It is basic requirements for everyone.  It is JUST for those who have this type of insurance. Please note" I am not a professional.  The best information is to call your provider.  This is just BASIC information.  AGAIN Basic Information.

Thank you White Dove...

is this available in TEXAS?