cherryjello

So the first thing I did was call my insurance (humana) last fall to find our what my coverage for surgery was. They told me its covered at 90/10 as long as you meet the criteria. Lady sends me a info sheet. I meet the criteria. I make my appt, go through all the steps. MD office submitted for pre-approval and I was approved within days. Had my surgery in January. Now am looking at claims online and finding most of them are denied. Called Humana...oh well, there is a MAX OF 10K lifetime for obesity coverage!! What?? This is the first I have heard of it. Called hospital billing and they will discount a certain portion for being cash pay, but still will owe around 30k. I feel like a total idiot here for not going over this with a fine tooth comb. Maybe I am expecting too much from my doctor's office, but I certainly thought they would have mentioned this to me when they submitted for approval. I am just beside myself. And certainly I should have been told when I called Humana. Husband looked it up and it is in the fine print of our policy. I am just so upset. Trying to look on the bright side and look at this as a huge investment in my future, but 30K??! Thanks for letting me vent.

Thanks all. I called the insurance and asked about an appeal, and the guy looked back at the notes form when I called them in September and said that the notes say that I was informed of the 10k max. Now if I was, I certainly don't recall it. Maybe it didn't register in my old brain. I don't know. I called the doctor's office billing person, and they said that they were not aware of the 10k max from my insurance. How is that possible?? I also asked if I could just ask Humana to revoke the claims and do self pay, since that would be cheaper at this point. She said no, that it would be insurance fraud since I already had the procedure. @@number1rudegal and @@losergrl75 do you know if this is true?

No drain for me

I have been able to drink 8 oz broth and Protein shakes no problem for past couple of days. My doctor's post op diet is full liquid, which includes greek yogurt. I just tried that today was able to eat a 5.3 oz cup, no problem. I feel satisfied, but not full or anything else. I thought sure yogurt would make me feel some restriction since it is not very liquid-y. Freaking out a little! I plan to ask my doctor about it but I don't see him for over a week. I hope my pouch isn't too big or there isn't an issue???

Thanks all, just needed the reassurance! Seems like most early pre-ops say they can only eat a few bites, etc. and I feel on the complete opposite end of the spectrum. Will keep on keeping' on