I had 6 challenging months with a Humana HMO, but finally was approved after my search started. :whoo: This is a good thing, because w/o insurance it would have cost me $16,700 for the 2 surgeon team & hospital I chose. There was a requirement, though, for patients paying via insurance to pay a program fee that was a small chunk out of pocket, but it was well worth it due to the expertise of our surgical team and the care we received both pre/post op at this incredible hospital.
My mom and I both had surgery done a month and a half apart at the same place. We first spent months of doing our "homework", then went to their seminar in January, and then had surgery - Mom in early May and me at the end of June. Mom had an easy time of it because she has Cigna and their approval was automatic as long as she had the documentation.
The seminar was invaluable in letting us know what type of paperwork to begin collecting, although I already knew most insurance companies required 6 months up to a year's worth of monthly doctor monitored care w/ possibly appetite suppressants. I already had almost a year's worth of care under my belt when we went to the seminar, so that was covered. I even had a year's worth of gym membership by that time also.
The surgeons informed me that I would have a real fight :boxing: with my insurance company due to it being an HMO (and I'm under a school district contract/policy, so...) and that they had NEVER had a Humana patient before that got approval. :omg: I informed them that I planned on being the first, due to all the documentation I had collected. Preliminary calls to Humana told me I "could" get approval if I had all the steps followed and paperwork. I can only hope what I went through in gaining approval helps future Humana HMO patients that come to them. It wasn't that Humana people were rude (a little condescending, yes) but every time I called, I got a different set of instructions from a different person. Very aggravating sorting through the bureacracy! :(
My PCP was terrific in writing a letter supporting my medical need for the surgery and copied all my files/labwork going 4 years back along with a bunch of other needed papers....needless to say the fax to Humana was 53 pages long!!! Humana told me to expect 2-4 weeks for their review board to look over my "case" and then I would hear back. Within 3-4 days after that massive fax, I got approval. :clap2: It was time to celebrate!!!! :whoo:
I've heard it said that if you don't get approval from your insurance company and it goes into appeals, forget it - you'll never get approval. I say to those of you in that situation, what have you got to lose? Keep trying! My case goes to show you that even what looked dismal at first turned out to be the cloud with the silver lining!
Banded 6/27/07 - VG band, Dr. Jose Erbella and Dr. Gary Bunch, Manatee Memorial Hospital, Bradenton, FL
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REbanded 8/13/07 
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