Humana – Insurance Requirements for Weight Loss Surgery
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:
- 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
- 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.