Surgery covered, but not the visits to my surgeon.

[lessoflittlebit 8]

I have Humana. I went to the surgeon for the first time last month - he scheduled a Venus Doppler and EGD, etc. A few weeks later I get a bill for $289 for that appointment. Not the tests...just seeing the doctor! I called Humana and they said the surgery would be covered but not the visits to my surgeon. I think that is insane! They said they don't cover anything coded "morbid obesity" other than the surgery itself and lap band fills, which doesn't apply to me. I called the billing department back and they said they would try to rerun it with a different coding, but they couldn't promise anything. Has anyone else run into this?

Louisville, KY ~ RNY June 2013 ~ Sent from my iPad using RNYTalk

[ArmyOfMe 82]

Tricare Humana?

[lessoflittlebit 8]

I don't think so...Humana PPO for KY educators.

Louisville, KY ~ RNY June 2013 ~ Sent from my iPad using RNYTalk

[ArmyOfMe 82]

Oh, ok. If it was Tricare, I could have helped a bit but I don't really know much about the other Humana branches. Hopefully, you will find some answeres soon. Good luck!

[Nel 189]

Luckily the surgery is covered! My insurance BCBS of Arkansas, covered 4000 MAX. So it was 12 grand out of pocket.

[TinyMamiOf3kids 1,280]

That sucks! ????????

[HeroOfThisStory 24]

I have Humana. I went to the surgeon for the first time last month - he scheduled a Venus Doppler and EGD' date=' etc. A few weeks later I get a bill for 289 for that appointment. Not the tests...just seeing the doctor! I called Humana and they said the surgery would be covered but not the visits to my surgeon. I think that is insane! They said they don't cover anything coded "morbid obesity" other than the surgery itself and lap band fills, which doesn't apply to me. I called the billing department back and they said they would try to rerun it with a different coding, but they couldn't promise anything. Has anyone else run into this?

Louisville, KY ~ RNY June 2013 ~ Sent from my iPad using RNYTalk[/quote']

My insurance is the same way. I work for my insurance company so might be able to give you some insight but it also depends on what your doctor is willing to do. My surgery and hospital stay is covered but no 6 month diet or anything is, which is a requirement. Nothing pertaining to weight loss or morbid obesity is a payable diagnosis for my company with the exception of the surgery. I explained this to my surgeon and since my blood pressure has been high when I visit him, that becomes a medical condition therefore it's completely legit for him to use that diagnosis as my visit, same with my nutritionist. That diagnosis is payable with my insurance. Do you have any other health issues? The doc should have no trouble resubmitting it. Of course you do have to have something wrong, I'm definitely not saying to make up something. Hope that helps.