Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 I'm going to throw my $.02 worth in here too. I am a Rabkin patient, I paid the $3,000 program fee and I am grateful that my insurance pays for the surgery. If I were to be self-pay, I would probably have decided to go to Spain because I would have to be shopping price. Fortunately, I don't have to do that. I had an appt with my medical group's weight management specialist last Thursday. He felt that since I had to pay a $3,000.00 program fee that I would therefore be more diligent in following the program as a post-op, getting the nutritional support, following the instructions and following up with an exercise program. After I described Dr. Rabkin's follow-up program, he was very impressed. He said that when you have to pay, you tend to be more likely to succeed. The surgery is a TOOL, not an end to itself. If I wish to be 100% successful, I have to put in 100% of an effort to watch what I eat and exercise for the rest of my life. I can fail to lose all my excess weight if I don't make good choices of what I eat. I don't have lots of money, but I was willing to figure out a way to pay the program fee because I want this so very badly. Again, if I had to self-pay, it would have been a different story, and I would have gone to Spain because it is cheaper. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ P.<A HREF= " apapararo@... " >apapararo@...</A> BMI: 50.1, 5'7 " , 320, age 40 Pacificare/Sutter Medical Group/Approved Dr. Rabkin/Dr. Jossart BPD/DS SURGERY DATE: 11/27/00!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 I think this issue is more complicated than a cost being judged lacking in medical necessity by the insurance companies. It is not news to anyone that there are some BIG problems with medical insurance policies and what they do and do not deem necessary. This board is full of posts about the struggles patients are having getting their insurance to approve coverage of a medically necessary surgery. Is it any suprise that there might be problems with the actual coverage once a surgery is approved? There have been numerous reports here of how little of the surgeon's fee is actually paid by the insurance. Many Insurance companies will not cover initial visits. Personally I have had my own insurance try to dictate to my Dr and me what drug I should be taking, because there is a cheaper (but not effacious for me as it turns out) option that is similar. Had I lost that argument with Aetna would it have made sense to say that because they deemed it medically unnecessary, I should swith to the meds that don't treat my condition as well? I don't think so...... and I wouldn't consider my Dr unprofessional to recomed a drug that the insurance wouldn't cover. In this particular instance Dr Rabkin provides the services that the insurance claims are unnecessary and as such he charges for them. But essentially the issue is the same one. Who should be deciding what we need medically? Our Drs or our Insurers? I can understand making the decision to go with another Dr, I considered it myself. but I would hesitate to lable Dr Rabkin unethical, or a price gouger. Consider it in this light: He is SO ethical that he refuses to compromise his patient's care and is essentially forced by the policies of the insurance companies to charge more than they will pay for his services. Tough issues, huh? > Hi M from another M > I called the SF office and when I heard about that $3000 fee I crossed them > off my list pronto. For my money this is unethical and borders on price > gouging. I would not use a doctor that required $3000 for a purpose so > lacking in medical necessity that no insurance company will consider paying > for it. > > I found myself another doc fast. > > in Seattle > > ----- Original Message ----- > From: " mary magdeline " <mmagdeline@h...> > > > I'm going to go to the meeting but I'm in > > shock after receiving my info package and hearing the $3000 fee > information. > > > > MM Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 With Dr. Rabkin, the $3000.00 program fee pays for unlimited access and appointments for lifetime follow up, not the surgeons fee. This pays for Delphine's time, you get unlimited access to her 24/7. You also get all the follow up appointments included, no extra costs ever! So I am not going to complain one bit because I do expect to get my money's worth. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ P.<A HREF= " apapararo@... " >apapararo@...</A> BMI: 50.1, 5'7 " , 320, age 40 Pacificare/Sutter Medical Group/Approved Dr. Rabkin/Dr. Jossart BPD/DS SURGERY DATE: 11/27/00!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 In a message dated 11/4/00 12:38:12 PM Pacific Standard Time, marym@... writes: << I think it makes more sense for folks using their services after surgery, However, insurance pays for those visits.. are you certain they don't also bill insurance? >> My insurance doesn't cover the support groups, nutritional seminars and other care that is part of the program. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ P.<A HREF= " apapararo@... " >apapararo@...</A> BMI: 50.1, 5'7 " , 320, age 40 Pacificare/Sutter Medical Group/Approved Dr. Rabkin/Dr. Jossart BPD/DS SURGERY DATE: 11/27/00!!! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 In a message dated 11/4/00 1:35:06 PM Eastern Standard Time, marym@... writes: << nd FWIW I think the surgeons ought to give her $3k back with interest. Her website (and this list) have done more to inform and educate DS patients than any single provider could ever do. >> YES!!!! I totally agree!!! W Pre -op Dr. Denied on 10/26 and fighting mad!!! - Prudential POS 5'5'' 301 - BMI 51 Mire fuera de Prudencial, está muy enojado.... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 Interesting that more are considering extra fees. I called all over in trying to decide where to go for surgery and the SF office was the only one mentioning such a fee. A trend for charging more would be important information to have for those looking for surgery. It is to be noted that when the surgeon is part of the staff of a teaching hospital-- such as a medical school (University of Washington and OHSU, for example) the fees are set by the institution and the surgeon does not get extra $$ for his/her work. RE: Fees and charges > > > > > > > > This sort of fee isn't changed by surgeons doing heart valve > > > > replacements-- another surgery needing extensive lifelong > > > > follow-up. > > > > > > , do you have any info on what the charges are for heart valve > > > replacements, and what the insurance companies are paying for this > > > procedure? I do see the parallel, but unless the heart surgeons are > > getting > > > a comparable percent of reimbursement, this argument doesn't > > hold water... > > > > > > M. > > > > > > --- > > > in Fremont, CA, age 38 > > > Starting weight 299, now 178 > > > Starting BMI 49.7, now 29.6 > > > Lap DGB/DS by Dr. Rabkin 10-19-99 > > > http://www.duodenalswitch.com > > > > > > Direct replies: mailto:melanie@... > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 Joe.. Even if the surgeon gets their full fee they *still* charge the $3k. We differ in our views of people only having the right to health care if they have the $$ for it. I consider it a basic right like education. But that's a political thing and not really relevant to this list. What is disturbing is that the $3k fee seems to intentionally exclude lower income folks. I *don't* like that. ----- Original Message ----- . I > think I'm worth it. " That's capitalism and I don't object to it. > Yes, it is " what the traffic will bear " and I applaud it. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 This discussion is interesting. I have a completely different take on it than most seem to, however. We all talk about surgeons who decide to do this surgery rather than the RNY because they feel it is to the benefit of the patient to have it. They have more skill than the average surgeon so are able to do the more complex surgery. They will take more time to do each proceedure so in the long run will receive fewer fees. The have more training than the surgeon who " only " does the RNY as most can and do perform both. I know that the surgeons charge somewhere from $10,000 to $20,000 aside from the hospital costs. But the insurance companies when they do fund may pay them between 50% and 25% of that amount, simply because they can get away with it. What is wrong with a surgeon saying that their services are worth more and that if the insurance company is going to short them they want to get paid extra and for that extra will give better than average after-care? Now whether any speficic surgeon is worth $3,000 more or not or whether that extra after-care is worth it or not is something each of us has to decide. But I have no problem whatever with their charging it. If I want a car and want a Cadillac rather than a Chevrolet I will have to pay $10,000 more. What's wrong with a surgeon saying " If you want me you'll have to pay $3,000 more. I think I'm worth it. " That's capitalism and I don't object to it. Yes, it is " what the traffic will bear " and I applaud it. Just my $.02. Regards. > And people who self pay his entire surgical fee also have the opportunity to > pay the additional $3000 fee. Even if that person will be totally followed > by their private physician in another state. This is not to say that the > individual surgeons are not skilled and caring. My opinion is that charge > is akin to a toll charge for being obese-- what an obese person is asked to > pay in order to be seen by these folks. If that isn't insulting, tell me > what is. It also brilliantly excludes medicare and other low income folk > who can't afford this. > > This sort of fee isn't changed by surgeons doing heart valve replacements-- > another surgery needing extensive lifelong follow-up. Nor is it charged by > the many many other surgeons who give excellent care and fight the *good > battle* with insurance companies on behalf of their patients. It is > possible to mentally justify about anything someone does. People who want > to attribute ethics and better care to the physicians as what they get form > the $3K is fine with me. Looks a lot like " whatever the traffic will bear " > to me. > > in Seattle Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 In a message dated 11/4/00 2:17:26 PM, duodenalswitchegroups writes: << Interesting that more are considering extra fees. I called all over in trying to decide where to go for surgery and the SF office was the only one mentioning such a fee. A trend for charging more would be important information to have for those looking for surgery. >> The upfront fee of 100 bucks required by Dr. Macura's office turned me off, too (nothing compared to 3k, but I don't think that is upfront). I wanted to at least get the consult first and I had the insurance referral... I didn't understand why I had to pay a non-refundable fee before even seeing the surgeon. I told the nutritionist that I had an appointment with my PCP's nutritionist and asked if her visit was covered by Oxford. She said 'no, this is how I make my money!' That really turned me off! Hey, 100 isn't that outrageous and if it's for the supplemental program (like support groups, etc.), I'm not going to knock anyone for paying it. Dr. Macura comes highly recommended (by my PCP and I'm sure by others), but the impression I got about the fee was just that -- IT was an 'extra perk' to collect some profit from the WLS because it is so in demand. I think that this issue goes beyond just WLS -- I agree with , really, that if one has an insurance contract and the doctor has agreed to such fees, then no additional extra charges should be necessary. I don't think such fees are usually assessed for other surgeries - why for WLS? Mainly, because it's popular, in high demand (especially by the top surgeons) and the 'market will bear'. Yes, it is also to supplement the generally crappy compensation that doctors receive from insurance. However, it is their choice to participate in insurance plans or not... I think this entire issue is a valid concern and also an upcoming trend for many doctors and surgeons who are becoming fed up with the HMO machines and not getting compensated enough for their skills. I can see their point of view, but I can also see the insured person's perspective as well. Obviously, there is need for reform of some sort and it may just be that many doctors will start charging extra 'fees' for certain high-demand procedures. I remember when I called about Dr. Goodman (also highly respected and recommended here in the Bronx -- but he only performs open RNY) the receptionist said he USED TO take Oxford, but has gone 'independent'. His associate, Dr. Driscoll is the one in the practice who stayed in the network, but the more popular Dr. Goodman isn't. I can understand his point of view in a way. But, I can also see where those who are covered by insurance will be offered less and less of a variety of options.... Either they will have to pay additional fees or they will have to go totally out of network to see the best surgeons. It's a real catch-22, IMHO. all the best, initial consult with Dr. Gagner, Mt. Sinai/NYC, Nov. 15 - can't wait! :) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 In a message dated 11/4/00 2:17:26 PM, duodenalswitchegroups writes: << He said that when you have to pay, you tend to be more likely to succeed. The surgery is a TOOL, not an end to itself. If I wish to be 100% successful, I have to put in 100% of an effort to watch what I eat and exercise for the rest of my life. I can fail to lose all my excess weight if I don't make good choices of what I eat. >> This may well be true -- whenever one pays for something one is more aware of it's cost and value, etc. HOWEVER, when one is covered by insurance, one is STILL PAYING. There are bi-weekly deductions in the paycheck (sometimes quite sizable since the trend now is for companies to pass more of the charges unto the employee). There are co-payments, which admittedly are not that bad unless you have to frequent the doctor often. Then, there are medicine copays. Our copay went from 5 (for non-prescription) to 15 dollars! Sure, 15 is nothing compared to the cost of meds, but that's an over 100 pct price increase in a year's time. :) I'm not sure about medicaid, etc. but with HMO's and PPO's, the patient is still participating in the payment of medical care. It may only be a portion, but the money is taken out. all the best, initial consult with Dr. Gagner, Mt Sinai/NYC, Nov. 15 - can't wait! :) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 : Clearly we do have a real difference of opinion here. I am torn on health care. I expect I do agree that people have a right to *basic* health care. At least in our system as it's set up. But I don't feel that any surgeon should be told that he can't charge more if he feels he's worth it and he doesn't object to people being turned off by the extra charge. I don't have a problem with a surgeon saying he is not supplying the " Chevrolets " that everyone deserves but rather the " Cadillacs " that some will choose and pay extra for. And if this excludes lower income folks so be it. There are other surgeons who do RNY's. Or surgeons affiliated with med schools who don't charge an extra fee. I don't think that one surgeon who charges extra deprives ANYONE of care, just of HIS care. I know that bothers you and not me. We'll just have to agree to disagree on this point. Regards. Joe Frost, old gentleman, not old fart Pre-op, San , TX 60 years old, BMI 48 Dr. Welker, Surgery Scheduled 11/29/00 http://www.duodenalswitch.com/Patients/Joe/joe.html > Joe.. > Even if the surgeon gets their full fee they *still* charge the $3k. > We differ in our views of people only having the right to health care if > they have the $$ for it. I consider it a basic right like education. But > that's a political thing and not really relevant to this list. What is > disturbing is that the $3k fee seems to intentionally exclude lower income > folks. I *don't* like that. > > > > ----- Original Message ----- > From: " Joe Frost " <joefrost@e...> > . I > > think I'm worth it. " That's capitalism and I don't object to it. > > Yes, it is " what the traffic will bear " and I applaud it. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 I think it makes more sense for folks using their services after surgery, However, insurance pays for those visits.. are you certain they don't also bill insurance? I specifically asked about the charge for someone who would only see the doc as a surgeon and have all their after care elsewhere. Still $3k. I also asked if self pays had to do this and was told yes, there are no exceptions. I have heard wonderful things about the docs there.. and certainly credible reports from their post ops here. My view is still that a surcharge is wrong. I respect the views of others and can see that for some it was worth it. One of the things I love about this list is that there is room for respectful disagreement. And I have no need to beat a dead horse.... I'll just await the next time the subject comes up LOL. I'm grateful to all the fine surgeons who do the DS and bring about such remarkable changes to our lives. ----- Original Message ----- > With Dr. Rabkin, the $3000.00 program fee pays for unlimited access and > appointments for lifetime follow up, not the surgeons fee. This pays for > Delphine's time, you get unlimited access to her 24/7. You also get all the > follow up appointments included, no extra costs ever! So I am not going to > complain one bit because I do expect to get my money's worth. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 In a message dated 11/4/00 2:17:26 PM, duodenalswitchegroups writes: << What is wrong with a surgeon saying that their services are worth more and that if the insurance company is going to short them they want to get paid extra and for that extra will give better than average after-care? >> The problem is that they signed a contract with the insurance company to accept x amount of payment as average and normal when they got on the boat! In a sense, charging the extra money to the patient is a kind of violation of the contract. I'm not saying that the extra fee is unwarrented nor that doctors don't deserve it. Obviously, there has to be some kind of reform that allows doctors with above average experience to reap above average compensation. Also, those in areas with higher costs to get higher compensation. But, as it is presently and how I understand it, the doctor signed a contract with the insurance company and has set, agreed upon fees. I think it is frustrating b/c I don't know how easy it is to adjust these fees with every contract renewal. I think this is why many doctors are 'dropping' certain insurance companies. While I can understand their point of view, for the consumer this really does limit choices and the patient's ability to seek out top physicians for treatment under their insurance plan. All the best, initial consult with Dr. Gagner, Mt. Sinai/NYC, Nov. 15 - can't wait! :) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 , this isn't the case with Dr. Rabkin. I believe that they reimburse the fee for any amount over and above the surgeon's fee if the insurance reimbursement + program fee exceeds that amount. > Re: Re: Fees and charges > > > Joe.. > Even if the surgeon gets their full fee they *still* charge the $3k. > We differ in our views of people only having the right to health care if > they have the $$ for it. I consider it a basic right like education. But > that's a political thing and not really relevant to this list. What is > disturbing is that the $3k fee seems to intentionally exclude lower income > folks. I *don't* like that. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 Hi, I just had to say my .02 worth. I had at first a problem with the fee. I thought.. well I will go else where. " Elsewhere " meant traveling. I live an hour away from SF. By the time I paid for tickets and lodging for " elsewhere " it was expensive that way too. I want my kids to be one of the last things I see before I have this surgery. I want my parents there and my friends. If I was to travel my husband would have to miss several days at work . We would surpass $3,000 by the time everything was said and done. Not to mention that I would have to travel several hours either by plane or car. I don't have alot of money. I am going to charge this fee. I don't want to do this. We just got out of debt. But, I have to agree with Joe, I don't HAVE to go to him. I don't have to use his services. I plan to make USE every service he provides with that fee!! I WILL make that fee count! Also, the Bay Area is outrageous as far as the cost of living! Everything is OUTRAGEOUS! I am NOT surprised he charges a fee just because of the fact he is in SF. Also, I would wager..that if someone came to him with a financial problem so great.. well.. I would like to think something could be worked out. I would hope that my fee would cover those who could not find the money to pay the fee...I plan to get a job after I lose weight and pay off my debt. When I broke the news to my husband that there was a fee.. I told him.. " Look, I paid that and more in vet fee's for my cat who almost lost an eye and a dog who ate Tylenol PM...>Each time I worked and paid off every dime. This is even more important. " I understand what you are saying . Really, I do. But, I guess it will probably be an issue where people have to agree to disagree.. I'am really proud of this list to be able to discuss something like this with out resorting to flaming...HOORAH!!!!And I agree with you about Melonie getting her fee back!! LOL!!! Peace, From: apapararo@... > > >With Dr. Rabkin, the $3000.00 program fee pays for unlimited access and >appointments for lifetime follow up, not the surgeons fee. This pays for >Delphine's time, you get unlimited access to her 24/7. You also get all >the >follow up appointments included, no extra costs ever! So I am not going to >complain one bit because I do expect to get my money's worth. > >~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ > P.<A HREF= " apapararo@... " >apapararo@...</A> >BMI: 50.1, 5'7 " , 320, age 40 >Pacificare/Sutter Medical Group/Approved >Dr. Rabkin/Dr. Jossart BPD/DS >SURGERY DATE: 11/27/00!!! > > > _________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com. Share information about yourself, create your own public profile at http://profiles.msn.com. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 hey Saundra.. weren't we just discussing problems with staff in the office? there you go.. two different people, two different stories. I like your story better than mine ----- Original Message ----- > : I am a self-pay with Dr. Rabkin. I was told self-pays do not > have a program fee. > Warmest Wishes, Saundra (Sandy C) > > \ > > I understand your question, . However, this charge is > leveled at > > self pay folks as well. And for people who will be calling their > own PCP in > > another state. You are suggesting that the reimbursement for WLS > is far Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 : I am a self-pay with Dr. Rabkin. I was told self-pays do not have a program fee. Warmest Wishes, Saundra (Sandy C) \ > I understand your question, . However, this charge is leveled at > self pay folks as well. And for people who will be calling their own PCP in > another state. You are suggesting that the reimbursement for WLS is far > less than the actual charges. AFAIK, this is true for all surgical > reimbursements. The obesity field has far more people wanting surgery than > there are surgeons offering it. This fact has made possible the 30 minute, > 9 a day surgery mills (dangerous procedure) and the very high charges of > some surgeons. When WLS is offered everywhere by thousands of competent > surgeons, this practice of extra charges and fees will stop. > > BTW, most insurance companies will reimburse for consults-- including those > done on the phone. > > There are some insurance specialists on some of the WL lists who may know > about reimbursement. I know that some of the cardiac surgeons I worked > with used to snort at the low fees paid by insurance and medicare. > > > > > RE: Fees and charges > > > > > This sort of fee isn't changed by surgeons doing heart valve > > > replacements-- another surgery needing extensive lifelong > > > follow-up. > > > > , do you have any info on what the charges are for heart valve > > replacements, and what the insurance companies are paying for this > > procedure? I do see the parallel, but unless the heart surgeons are > getting > > a comparable percent of reimbursement, this argument doesn't hold water... > > > > M. > > > > --- > > in Fremont, CA, age 38 > > Starting weight 299, now 178 > > Starting BMI 49.7, now 29.6 > > Lap DGB/DS by Dr. Rabkin 10-19-99 > > http://www.duodenalswitch.com > > > > Direct replies: mailto:melanie@t... > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 In this particular instance > Dr Rabkin provides the services that the insurance claims are > unnecessary and as such he charges for them. But essentially the > issue is the same one. Who should be deciding what we need > medically? Our Drs or our Insurers? > > > > > > > > Hi M from another M > > I called the SF office and when I heard about that $3000 fee I > crossed them > > off my list pronto. For my money this is unethical and borders on > price > > gouging. I would not use a doctor that required $3000 for a purpose > so > > lacking in medical necessity that no insurance company will consider > paying > > for it. > > > WOW! I just read this today. I emailed Dr Rabkin's office on Thursday and did not hear back from them. It may be because I said in the email that I heard they charge an extra $3000 and I thought that was illegal. I asked them if that was true? Guess that's why I didn't hear anything back! Seriously though, I do think their extra charges are illegal. The money that is paid by an insurance company to a surgeon is technically supposed to cover all pre op and post op visits plus the surgery. It is amazing to me that if he is charging extra to patients directly that no one has turned him into the California Insurance Commission. Maybe the laws are different in Californis, but I have a master's in case management and I can tell you that having to pay " extra " for post operative visits etc is illegal in Pa and most of the east coast. I think it's kind of sad that we are so desparate for health care and for weight loss that most of us would do anything to get it. I also think it's really unethical of a surgeon to charge extra for those services and am appalled that it would be considered ok by anyone. Jeannie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 > WOW! I just read this today. I emailed Dr Rabkin's office on > Thursday and did not hear back from them. It may be because I said in > the email that I heard they charge an extra $3000 and I thought that > was illegal. I asked them if that was true? Guess that's why I > didn't hear anything back! I know that Delphine doesn't necessarily check email every day, so I bet she hasn't seen your message yet. > Seriously though, I do think their extra charges are illegal. The > money that is paid by an insurance company to a surgeon is > technically supposed to cover all pre op and post op visits plus the > surgery. Rabkin isn't the only one to charge a program fee, and the DS procedure isn't unique to this. Many WLS surgeons charge such a fee, and it isn't illegal. I've only ever paid $the 15 co-pay for my initial consultation; Dr. Rabkin's office has never charge me or billed insurance for any office visits beyond that. The program fee is stated to be for all the non-office visit services they provide such as the support groups, ongoing research, 24-hour telephone availability, etc. I've also gotten lots of free samples of vitamins from Delphine and never been asked to pay a thing for it. The fact that they reimburse all or part of the program fee is a courtesy that they extend to people who are fortunate enough to have decent insurance reimbursements. As far as I know, nobody pays more than the surgeons fee in total. In my case, my surgeon fee was $9300, and my insurance paid something like $2300 total. For the rest of my life as a patient of this program, that isn't a whole lot to pay, I think! I don't blame them for wanting to recover more so they can meet their overhead. The insurance thing is a catch-22. On the one hand, if the surgeon stays in the insurance networks, the patient benefits by not having to self-pay everything. On the other hand, to meet some peoples' moral criteria, they would have to completely out of the insurance networks, and then only wealthy patients could afford him. The docs get demonized for wanting to recover more of their fees and costs, but if they opted out of all the insurance networks, they'd get demonized for that too. M. --- in Fremont, CA, age 38 Starting weight 299, now 178 Starting BMI 49.7, now 29.6 Lap DGB/DS by Dr. Rabkin 10-19-99 http://www.duodenalswitch.com Direct replies: mailto:melanie@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 > > The insurance thing is a catch-22. On the one hand, if the surgeon stays in > the insurance networks, the patient benefits by not having to self-pay > everything. On the other hand, to meet some peoples' moral criteria, they > would have to completely out of the insurance networks, and then only > wealthy patients could afford him. The docs get demonized for wanting to > recover more of their fees and costs, but if they opted out of all the > insurance networks, they'd get demonized for that too. > : I think this, in a nutshell, is the crux of things and things to come. The doctors are trying to get properly compensated yet also trying to provide for as many patients and as wide a variety of patients in the socio-economic spectrum as possible. Some *may also* be charging fees because it is a lucrative surgery (and I am NOT by any means referring to ANYONE in PARTICULAR with this statement! Just wanted to clarify that:)) I think such additional'perks' like counseling, suport groups, etc. (although they are necessary they are not necessarily mandatory and don't have to be provided to the extent that they are in many cases) CAN be used as a justification for additional fees, but this also means that some *may* not be able to afford access to a particular top-of-the-line surgeon and/or may be paying valuably for it. I'm not in any way saying anyone who has paid a fee shouldn't have or isn't justified in doing so. :) All the best, initial consult with Dr. Gagner, Mt. Sinai/NYC, Nov. 15 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 dr. r isn't the only one that charges a fee for after care program i called dr. k and their office told me that the charge was $2000 so that's not far behind dr. r's....oh well, what can ya do? i have a consult w/ dr. a, 11/27 and am having trouble coming up w/ the initial consult fee of $250....annie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2000 Report Share Posted November 4, 2000 How many of the doctors patients have been denied for surgery after the doc spending many hours trying to get them accepted. For every denial we see on here multiply that 1000 fold. You might get a little better picture of the frustration a doctor has. How many emails a day does a doc receive? How many appointments broken, surgeries canceled (bet they still have to pay hosp for OR time). We ae serious about trying to get something done. And are often told by our insurance companies " NO " so, how does a doctor go about re- couping lost time. By charging a fee upfront, whether you make it or not? I can agree with $100 or $200. And when you consider the SF area where office space is 100 times the expense normally incurred, I guess $3,000 is on the same level. It freaks us out when we see that huge sum but I know my sister lived in SF and they paid $2,500 per month for a 800 square foot apartment to rent and the condo's sold for $350,000 with the square footage of 1000'. I have not heard or did not understand: is the $3,000 fee paid in advance of filing insurance? I just hope that soon this dispute over DS and the insurance companies would get over soon. I heard that this surgery type was previously done for people with cancer. Wonder what code was used for that? LOL wonder if that code would work? I wonder why it is because we want to KEEP a body part we are being denied. The RNY distal is very similar in concept to the DS. Difference being we keep certain body parts. Quote Link to comment Share on other sites More sharing options...
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