Bariatric Management Services
Humana's bariatric management team explains benefits, options, and more:
- Benefits explanation
- Review of bariatric surgery medical necessity criteria
- Types of bariatric surgeries covered under the member's plan
- Guidance in selecting in-network providers, including a bariatric surgeon and a facility that is a Bariatric Center of Excellence
- Pre-surgery educational video modules
- The surgery pre-determination process
Your surgeon faxes or e-mails your clinical information to Humana's bariatric management team requesting an authorization for surgery. The bariatric nurse reviews the clinical information as well as provider and hospital Bariatric Center of Excellence status. The bariatric nurse assures the medical necessity criteria has been met and, if necessary, consults with the bariatric regional medical director.
If you have a Health Maintenance Organization (HMO) plan, your primary care physician (PCP) can send your referral for bariatric surgery to the bariatric management team, who will enter it into the Humana system. Your PCP will also need to send a copy to the surgeon's office.
Preferred Provider Network
The bariatric hospital and the surgeon must be designated a Center of Excellence to be in-network for bariatric surgery benefits. To receive in-network certification, both surgeons and hospitals in Humana's bariatric surgery network must be certified as a Center of Excellence by one of the following:
The hospital and the surgeon must also be in your health plan's network for you to get the highest level of coverage.
Humana's network of providers is growing rapidly, so call the Bariatric Management Program to find out if your surgeon and hospital meet your plan's coverage criteria.
How To Reach Our Bariatric Management Team:
There are several confidential ways members and providers can reach Humana's bariatric management team of nurses and benefit specialists:
A member's information is kept confidential. Please include member name, Humana ID number, and date of birth with all e-mail and fax requests for benefits, criteria, pre-determination requests, or any other questions.
For Billing Questions:
Phone: call the customer service number on the back of your Humana ID card
Mail: use the claims address on your Humana ID card
These programs and tools are not insurance products and are not guaranteed under any contract. Humana is not required to provide these services, but makes them available to eligible members at no additional cost.