Insurance Saga Continues

The clinic totally screwed me. Technically speaking. They will be issuing me a refund as soon as my insurance (U*H*C) money gets there, just not for as much I was anticipating based on what I was told at the beginning. This has taken a dozen phone calls and me coming near to tears a couple of times to get figured out. I think I've figured out a way to "fix" it though.

The $8,300 I paid them covers the procedure AND all aftercare for 13 months, however when they bill insurance it's only under the "procedure" code. U-H-C said 3,389 is reasonable and customary for the procedure and paid 80% of that. I'm fine with being responsible for the other 20% . But what this means is that I paid cash ($4911 or whatever is left after you subtract the actual procedure fee, I don't have an itemized list of charges.) for all of my aftercare.

They will not/do not bill for aftercare as you go because with their contracted insurance companies there is a "global period" where they will not pay for anything regarding the procedure for 13 months. I'm assuming because those companies *know* the initial fee covers that "global period" they have a higher r&c for the "procedure" than U-H-C. As far as I can find out, U.H.C does not have such a clause with regards to the Lap-band.

In essence the way they process their billing screwed me out of my insurance benefits for aftercare. For the time being anyway. My solution is to get a receipt for each adjustment appointment and submit the claim myself. If adjustments are covered and I've already paid for them then I am entitled to reimbursement, correct? Can anyone see a flaw in my logic??