I am going to possibly make one of the hardest decisions I have ever had to make. :(

[Rchavez101 0]

I had surgery on November 4th and have lost 83lbs to day. Everything started out great for about the first 2 months and then I started to have some issues. I was having issues with throwing up foam and went in to the doctor and they did a unfill. I had to go back several times untill they unfilled the band completely. I went in about 2weeks ago because I was still throwing up and there was no Fluid in the band. They did a live x-ray while I drank barium and you could see in the x-ray how it would pool up right before the band and slowly make it's way down. The doc was very surprised how tight it was for not having fluid.

I also have had issues with my port incision. It has been draining for about the last month and half. The doc has seen it and there is no infection. They gave me antibiotic cream so that I could change the gauze pads twice a day. At the beginning I had a hematoma and have had issues with the incision getting better and then worse then better then worse. There has been no pain associated with the draining.

To top off everthing my employer changed insurance at the beginning of the year and the doc does not accept the new insurance and they are the only doc in New Mexico. I was told that if we had pre existing appointments I would be covered for 90 days. I was givin the ok by the new insurance to go to my appointments. I have seen the doc for these issues about 3-4 times since the beginning of the year. I received statement in the mail yesterday from my insurance showing what they paid on one of the claims. They paid about $100 and I am responsible for about $1700. I called them to see what the deal was. The guy that originally gave me the ok told my wife that he may have mis informed me because they don't deal with anything with bariatric surgery. He said it was his fault but will have to look into it. So at this point I don't know if they are going to cover the appointments that I had or the existing bills. The doc that did my surgery is from Fort Worth texas and flies out to New Mexico to do the surgery. When my wife asked the insurance what were my options after the 90 days as far as seen a doc in network which includes my orginial surgeon but in Fort Worth. They said that my employer and eliminated any thing to do with bariatric surgery. So basiclly I would have no coverage what so ever.

I called my HR and they were upset with what I was told due to the plan should be the same as the one we had. Just different doc and network. So it should have been set up so that I could go in network although it would be out of state. They are going to look into it to see what is going on with the coverage for the 90 days and then what kind of coverage I should have after March 31. I have an appointment on March 3rd with the original surgeon so that he can see what are my options with the complications that I am having. At this point If I can get the ok that all bills will be covered with in the 90 days I may have them just pull the band out before March 31 since I don't know if I will have coverage after that. I don't want to put my family in a situation that could cause financial hardship. I have had issues with the band but since the last appointment I have really felt good as far as the vomiting foam. I think I can make it through the issues but since it is very inconsitent I am not wanting to take the chance with out knowing what will happen with the insurance after March 31.

I may have been rambling on and on but I am just venting. Worst case senario I hope they pay the bills for the 90 days.

[vlp1968 83]

Wow- I am sorry to hear you are having so many issues. Insurance gets so complicated, and you hear different things from different people. That's good your not throwing up anymore. I guess all you can do is keep up getting on your insurance carrier and hope they will eventually pay. I had trouble getting my prescriptions filled when my job switched companies. It took many phone calls to get it straightened out. Good luck!

[Keia 4]

Gosh, I wish I had some good advice to offer. I agree with the previous post, remain consistent in contacting the insurance company. I think they so no a lot hoping people will get tired of fighting and pay themselves.

I'll keep you in my prayers.

[ElfiePoo 109]

Sorry you're having issues with the band and the insurance company. It must be frustrating to have gone through so much only to possibly still lose the band.

.

[Humming Bird 275]

A few years ago my husband called the insurance company to make sure I still had coverage for some procedure. They told him I did. After I had the procedure we got a bill that said I had no coverage. I then called the insurance company and told them about my husband's first call. Come to find out, they record these calls and had to pay the bill because they told him in that call that it was covered.