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Scared! Someone please help!



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I was having horrible acid reflux and chest pains. Some days I can eat and some days I cant. The reflux is so bad it literally takes my breath away. I get extreme pain in my right ear then it moves to my teeth. Then it flows to my neck then my chest. My attacks can last up to an hour. I went to my doctor because i thought maybe my band had slipped. I did the xray and I drank the chalky liquid and it didn't flow through my band. It just sat on top. My doctor said that the band was collecting mucus and it was just sitting there. He noticed that my esophagus was in an "S" shape. He said the acid reflux has caused that. He sent the orders to my insurance company to have an EGD done to see what other damage is there. He labeled it as URGENT for the test and to get my band completely taken out. Well my insurance denied both. I have GERD, upper and lower intestinal bleeding and Anemic (and other things). I dont have the money to pay for these surgeries. I tried to get a lawyer but they all turned their back on me. Im so scared that something worst is going to happen. I dont know what to do. Im starting to panic. Someone please help or give me some advice. It will be greatly appreciated. I want to thank you in advance.

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I would appeal it immediately.

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I talked to the insurance again today and they said they wont cover anything Bariatric. I explained to them that Im NOT getting the Lap Band im getting it removed.

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They should have a department that handles these cases. Your condition could turn into something life threatening. It isn't voluntary elective surgery. If you end up in an emergency, requiring immediate surgery to remove the band, with they cover that??? I'd also ask about filing a written appeal, there should be a process to appeal first level rejections.

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Thank you. I will try that tomorrow when I call them. Im also going to ask about the emergency room. Great question. Thank you again.

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    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
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      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
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