Humana health insurance recognizes weight loss surgery as a viable solution for eligible individuals grappling with severe obesity. This article aims to provide a detailed overview of Humana's coverage for weight loss surgeries, including gastric sleeve and LAP-BAND procedures, eligibility criteria, and additional resources available to Humana members.
Humana's Commitment to Weight Loss Surgery
Humana understands the complexities of severe obesity and recognizes weight loss surgery as a viable solution for eligible individuals. Their coverage underscores a commitment to patient safety and long-term success in weight management.
Types of Weight Loss Surgeries Covered
Humana may provide coverage for several types of weight loss surgeries, including:
- Gastric Sleeve Surgery: This procedure, also known as vertical sleeve gastrectomy, involves removing approximately 80% of the stomach volume.
- LAP-BAND Surgery: This procedure involves placing a hollow band around the upper end of the stomach, creating a small pouch and a narrow passage into the larger remainder of the stomach. This is also known as Laparoscopic adjustable gastric banding (LAGB).
- Roux-en-Y Gastric Bypass (RYGB): In this procedure, a small stomach pouch is created to restrict food intake. This common malabsorptive weight loss surgery is also known as Roux-en-Y gastric bypass (RYGB).
Coverage Criteria
To qualify for weight loss surgery coverage under Humana’s plan, certain criteria must be met:
Body Mass Index (BMI) Requirements
Generally, a BMI of 40 or higher qualifies individuals for coverage. Individuals with a BMI between 35-39 may also qualify if they have obesity-related health complications.
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Pre-Surgery Assessment
Comprehensive medical evaluation to assess overall health and readiness for surgery. Documentation of past weight loss efforts and participation in structured programs. Evidence of the ability to maintain weight loss after surgery, such as previous attempts or a plan for post-surgical support.
Additional Requirements
A Body Mass Index (BMI) of 35 or greater along with a written letter detailing all prior attempts at weight loss programs, including diet and exercise, over the last 5 years may be required by Humana prior to covering any bariatric procedure. You may also be required to undergo a 6month supervised diet (nutrition evaluation) and a psychiatric evaluation prior to qualifying for Humana’s Gastric Sleeve Coverage in California.
Bariatric Management Team Support
Humana’s dedicated Bariatric Management Team provides personalized support at every stage of the weight loss surgery journey:
- Pre-surgery counseling and education to prepare individuals for the procedure.
- Post-surgery monitoring and support for up to six months to promote recovery and weight loss maintenance.
Coverage Details
Humana’s coverage for weight loss surgery extends beyond the procedure itself, including:
- Follow-up appointments and checkups
- Medically necessary nutritional counseling
- Support groups and resources for healthy lifestyle changes
Medical Nutrition Therapy (MNT)
Medical nutrition therapy (MNT) uses diet and lifestyle changes to help manage chronic health conditions. It’s not just about healthy eating; it’s about helping to make sure that what you eat doesn’t make your condition worse. In some cases, MNT may even help make your condition better or help you heal faster. If your doctor believes a dietitian may help you better manage your health, they can provide a referral. For many conditions, MNT is an ongoing need. For the first year, Medicare will cover 3 hours of MNT. For patients with diabetes or kidney disease or who have had a kidney transplant in the last 36 months, Medicare will pay 100% of the cost of medical nutrition therapy with no deductible or copay.
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Cost Considerations
It’s hard to know exactly how much your weight loss surgery may cost because it’s difficult to determine what services you may need during and after your procedure. If you are at an inpatient hospital, then Medicare Part A will help cover costs.
Humana Specific Coverage in California
Humana Health Insurance of Northern and Southern California will cover your Gastric Sleeve Surgery as long as your insurance plan's requirements for bariatric surgery are met. Each Humana California insurance policy can vary on what weight management or bariatric and gastric surgery expenses are covered or excluded, so it may be easier to have our Gastric Sleeve Insurance Coordinators verify your Humana Gastric Sleeve Surgery coverage for you. Simply give us a call at 1-855-690-0559 or fill out our FREE Gastric Sleeve Insurance Verification Form! Verifying your Gastric Sleeve coverage is hassle-free with no obligation. Every person is different, and so is each insurance plan; Humana’s Gastric Sleeve Coverage and pre-approval requirements in California vary with every insurance policy and potential patient.
Humana will cover your LAP-BAND Surgery as long as you meet your insurance plan’s requirements for bariatric surgery. While you can review your insurance policy package to see what weight control or bariatric management expenses are covered or excluded, you may find it easier to simply give us a call at 855-690-0560, or fill out our free, no obligation FREE LAP-BAND Insurance Verification Form so that our LAP-BAND Insurance Coordinator can verify your Humana LAP-BAND Surgery coverage for you. Just as each person is different; Humana’s LAP-BAND Coverage and pre-approval criteria varies with each insurance plan and prospective patient. Prior to covering any bariatric surgery, Humana requires a Body Mass Index (BMI) of 35 or greater along with a written letter describing your weight history for the last 5 years including all attempted diets, exercise and weight loss programs. You may also be required to undergo a 6 month supervised diet prior to qualifying for Humana’s LAP-BAND Coverage.
Additional Considerations
Coverage may vary depending on the specific Humana plan. Exclusions and limitations may apply. Individuals are advised to consult their policy documents and contact Humana for exact coverage details.
What About Ozempic?
Current law doesn’t allow Medicare to cover drugs prescribed solely for weight loss, but Ozempic is covered when prescribed for type 2 diabetes. Ozempic is just one brand-name version of semaglutide, a medication prescribed to treat type 2 diabetes. (Others common brands include Rybelsus and Wegovy.) Ozempic helps reduce blood sugar, which can reach dangerously high levels in people with diabetes. It’s been FDA-approved for this use since 2017. The list price of Ozempic (the original price determined by the manufacturer, NovoNordisk) is $968.52 per monthly injection, although most people don’t pay list price if they have insurance. To see what you would pay for an approved prescription for Ozempic, check your Medicare Part D plan’s formulary.
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Medicare Coverage
Medicare may cover bariatric surgery if you have a body mass index (BMI) greater than 35, you have at least 1 other condition related to obesity, and you have been unsuccessful with other medical treatments for obesity.