Question:
Has anyone fought and won this battle with Humana? in/out network due to RNY vs. VBG

Request for referal to Dr. Provost in Dallas for Lap RNY denied because Dr is out of network...Humana approved "in network" Dr. Hamn who only does VBG. Found Dr. Pilcher in San Antonio who is a provider for Humana HMO but is not in "my network" which is obviously different than "in network". I'm advised to see Dr. Hamn to determine that I am a candidate for this surgery, I've agreed to go though I'm leary that Hamn's determination will favor the surgery he performs rather that the Lap which I consider to be best for me and also I'm concerned that I'll be forced to accept Hamn and VBG if I want Humana HMO to pay. Solution/Suggestion/Sympathy??? All are welcome!    — Melanie B. (posted on April 19, 2000)

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