Unexpected Complications

Jennifer B.
on 10/8/07 7:49 am - FL
I had lap-band surgery two years ago and had no problem getting the surgery covered through BC of Cali.  Since that time, we have switched benefits and my employer is self-insured through Humana.   Our policy doesn't cover any WLS.  I've been having epi-gastric pain, nausea and vomiting, acid reflux and I'm no longer losing weight.  My surgeon is unsure of what is actually happening so he wants to scope me. My ultrasound showed gallstones so we know the gallbladder needs to come out. So, here is the dilemna.  I need an exploratory lap where the gallbladder will come out. The placement of the band needs to be assessed and if there is erosion, the band will need to come out.  The gallbladder surgery is covered under my policy but the band surgeon is considered out-of-network, so therefore, there is a higher deductible ($1,000) plus I'm responsible for 30% of the surgery costs.  If he touches the band or the band is mentioned on the claim, the whole claim will be denied according to Humana's customer service. I would like my to have the surgery covered as in-network ($75 copay) since there isn't anyone in-network who is able to take out my gallbladder who is also familiar with the band.  I would also like them to agree to deny only the items associated with the band and agree to pay for the rest of the gallbladder procedure. Anyone have any ideas for how to get this done?   Thanks!!!
Any transition serious enough to alter your definition of self will require not just small adjustments in your way of living and thinking but a full-on metamorphosis.
Martha Beck, O Magazine, Growing Wings, January 2004

Re-commiting to the bandster life!
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