Kathy's Surgery Expenses

Hi, my name is Jessica! My mother Kathy Golemon has worked for Louisiana State Police for 15 years and paid into the insurance system for OGB the entire time for health insurance,

In February 2022 she was diagnosed with Gastroesophageal reflux disease, a large hiatal hernia, and Barrett’s esophagus. The Barrett’s Esophagus at that time was biopsied and was pre-cancer 1 and 2 and could be treated after hernia repair with radiofrequency ablations. This would be performed every two months after the hiatal hernia was repaired.

My mother had a prior sleeve surgery that was self-pay which makes the only repair option a Roux-en-Y gastric bypass. The test performed showed the hiatal hernia was Type 1 long and sliding. This caused the sleeve (stomach) to go past the diaphragm and is sitting against her heart and lungs. Her esophagus is a maze with twists and turns with very poor function, and even if you could treat that with ablations the acid would continue to damage until it was fixed with reconstructive surgery,

The doctor submitted the request to complete all three surgeries to BCBS of LA. She needs two months to heal before they could start on the pre-cancer esophagus ablations. The only way to fix the severe damage to the esophagus is to create a new stomach and extend the esophagus to allow it to heal with acid damaging it more.

Well, Blue Cross and Blue Shield of Louisiana and the office of Group benefits denied the surgery. They said they do not pay for gastric surgeries and everything was caused by her prior surgery, and even if it was imminent they would not cover it. The cause of the problem is the hiatal hernia moving everything around and poor esophagus function has added to the reflux which exacerbates Barrett’s esophagus. After 1 year and seven appeals, they still are refusing to cover the surgery. We e cannot get an attorney that is willing to take the case, because the type of insurance is governed by OGB, and it is not subject to the state’s insurance commission or rules.

So now the hospital and doctor are willing to only charge 60% for the denied portion of the surgeries This total is $30, 500 plus whatever the new deductible is for the other two surgeries performed being this has gone on in appeals for a year. My mother’s physician is Dr. Reardon from Houston Methodist Medical Hospital. This hospital is rated 10th in the nation for gastric issues. He stated plainly in every appeal that this was not related to any prior surgeries and the reconstruction could only be accomplished with a gastric bypass. Even with that OGB and BCBS denied the claim and said any medical issues caused by this were not their responsibility.

With the cost of the surgeries, we are not able to raise the money ourselves promptly before the pre-cancer cells get worse. We have already added another year fighting with the insurance company.

Any donations would be greatly appreciated, anything helps! If you are not able to donate, sharing this and keeping her in your prayers would be appreciated too!

***03/02/23UPDATE****

Mom had an appointment in Houston with Dr. Reardon yesterday! Due to her condition worsening, he said we need to get the surgery done ASAP and is worried about the extent of the damage that's been done in the time we've spent fighting the insurance company. Her surgery is scheduled for April 4th! The original plan was 6-7 hour surgery with a minimum 1-night hospital stay. Since things have gotten worse, mom will be his only case that day and can't say for sure about the timeframe, but more than likely 8-10 hours with a 2-night minimum stay.

I can't express how thankful I am for everyone that has donated, shared, and prayed for mom! We’ve almost raised enough to cover the Anesthesiologist bill! Please continue to share her story and keep her in your prayers!