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Humana – Insurance Requirements for Weight Loss Surgery

In Am I Covered by admin

Humana does cover weight loss surgery unless specifically stated otherwise on your policy. In fact, Humana has a Bariatric Management Team. The Bariatric Management Team is available to help guide you through your weight loss surgery. The Team is also available for up to 6 months after surgery.

Humana’s Pre-approval Requirements

Humana requires the criteria below be met or exceeded in order to cover weight loss surgery.

  • Body mass index of 40 or higher
  • OR a body mass index of 35 to 39 with at least one comorbidity that may include:
    • Hypertension
    • Type 2 Diabetes
    • Severe Sleep Apnea
    • Joint Disease
  • A letter from your Primary Care Physician recommending weight loss surgery.
  • 6 months of a physician supervised weight loss program.
  • At least 18 years of age.
  • Patient completes and passes a psychological evaluation.

Types of weight loss surgeries covered by Humana

  • Gastric Bypass Surgery
  • Lap Band or Realize Band Surgery
  • Gastric Sleeve (Sleeve Gastrectomy) Surgery is reported to be covered.
  • Duodenal Switch Surgery

Are Lap Band fills covered?

Generally Lap Band fills are covered at in-network providers.

Procedures excluded from coverage

  • Stomaphyx
  • Mini-gastric bypass
  • Gastric Plication with a gastric band
  • Other investigatinal procedures

Does Humana Require a Center of Excellence?

Yes, Humana recommends an in-network surgeon and the surgery be performed at an accredited Center of Excellence.

Do I have to use an In-Network Bariatric Surgeon?

An in-network Bariatric Surgeon is strongly recommended. While you may be able to use a surgeon that is out-of-network, an in-network Bariatric Surgeon will have a lower out-of-pocket cost.

Humana Contact Info to Inquire About Surgery

If you are considering weight loss surgery and are insured by Humana, you should first contact the Bariatric Management Team.

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