I have my first appointment next Thursday (Feb 11th). I have to pay $300 cash for this appointment even though i have insurance that covers WLS. The WLS office told me i could submit my own claim to my insurance and they might reimburse me.

Has anyone ever heard or done this?

That does not sound right if you have insurance. Normally, they will bill ur insurance and whatever amount ur insurance does not pay they will send u a bill.

Not sure why they are doing that but I would call my insurance company and verify first or shop around for another doctor that is more patient friendly.

Something isn't right....it almost sounds like they are charging you a program fee....which insurance will NOT cover. Is there another bariatric surgeon you could consult with?

Mimi

Program fee is right. I went to a info seminar for the WLS group for Lowell Hospital in MA. They said that there was a $400 "program fee" not covered by insurance; $200 due at first appoint and $200 the day of the surgery. Their explanation was that this covered them doing information meetings, hand outs, etc. Since the meeting was held at the hospital and I'm sure the hospital owns a copy machine I was not impressed. I had researched several local surgeons and had chosen this facility because it was marginally closer to my house. I called the WLS group at the next closest hospital 45 minutes from my house and they did not have a program fee.

If at all possible find another facility. I think they make more than enough money on this surgery and should not be able to add a mark up as if it is a car.

i agree that it sounds more like a program fee that they are having you pay. my doc has one, too. it's $200 (not covered by insurance of course) and has to be paid on the day you do your pre op testing (that's monday for me). i don't quite get the whole program fee thing because couldn't they just include that in as part of the surgery price and then insurance would pay? that way they would get their money and the patient wouldn't be out the $200. but at the same time, i am not going to complain about it really because my procedure is covered 100% other than that program fee so i don't really mind paying it as to compared to what i would be paying if insurance didn't cover everything like it does. i could see someone being upset about it especially if they are self pay.

I made my first consultation appointment with a surgeon who asked for a $200 fee and then before I hung up they told me "Oh, by the way, we don't take checks or credit cards for the fee". After I hung up, my brain kicked in and I realized if this place is run like that what is the surgeon like? I called back and canceled.

Sometimes it has more to do with your insurance. My insurance company covers WLS but not the initial consultation. They do, however, have some kind of scale of what a reasonable charge for that service should be. I was charged $235 for the initial consultation, then the doctors office submitted the bill to my insurance company. BCBS of TX determined that $180 was the reasonable cost for the service, and that's all they would allow them to charge me, so I had a $55 credit on my account that I applied against what I had to pay to have my EGD done.

My surgeon has a program fee. It includes nutrition counseling/classes, educational materials, and access to exercise facilities. It is not covered by insurance.

At $300, it is among the lowest such fees in the area.

I don't think it sounds shady. If you're committed to using the surgeon, and enrolled as part of the program, then I would expect a program fee.

If they are a preferred provider with your insurance company they cannot bill you up front. They have to submit to your insurance company, get a denial and then bill you.

That might give you a little more time to come up with the money.

Like Betsy, my surgeon also has a program fee of $500, which I was able to pay over time- their only rule was that it be paid in full by the last preop visit. It included multiple nutritional counseling sessions, my psych eval, a whole 3 ring binder full of information, and monthly exercise/support group sessions (which I can continue and never be charged for again). Considering the level of care I have received by the surgeon and his staff, I gladly paid the fee.

Best wishes, Christine

If they are a preferred provider with your insurance company they cannot bill you up front. They have to submit to your insurance company, get a denial and then bill you.

That might give you a little more time to come up with the money.

This is not true. They can charge a program fee, and expect payment. Most insurers will not reimburse for the program fee.

You can choose a doctor who does not have a program fee--but IMO, that rules out some of the very, very best surgeons with the best aftercare programs.

I wouldn't let $300 stand between me and the doctor I have. Seriously, $300 (plus a handful of $35 copays preop) is small potatoes for the reward received.

I know it seems like a lot--but if you put OUT of your mind the notion that you are somehow being scammed and instead consider that the program fee might carry with it some very real benefits to you, it becomes lots easier to swallow.

Just echoing what others have said. My surgeon has $1000 program fee :eek:that is due in the fifth month of my 6 month supervised diet. This includes the psych eval, nutritional consult and dietician advice for life. I would be curious as to why they require it at the first appointment...are you sure you're going with this surgeon? If you're still deciding on a surgeon, I wouldn't pay anything until you've confirmed you're going through them.

Everyone,

Thanks for replying! I love hearing about everyones journey and the many paths everyone took to reach the same place.

I do intend on going to this surgeon since he is the only one in the area to accept my insurance. I have used the hospital before, when my baby boy was born, and never had a problem with it. The funny thing is I am the office manager for a group of anesthesiologists and I can't have the surgery at my hospital (which is a Center of Excellence) because the surgeons here don't take Tricare. Errrgg.... but oh well.

I just thought it was a little wierd that the office staff told me my insurance would most likely reimburse me but i had to pay for the visit up front. It just seems resonable to bill the patients insurance and then bill the patient...but that's from my point and i don't know squat about office billing.

I have the money saved so it really isn't that big of a deal plus Tricare covers almost all of the procedure, hospital stay, and etc. The center will also provide me: a book they called my WLS bible, meetings, support groups, and a nutritionist so if my money is not refunded by Tricare it won't be a huge loss because I will be getting an improved life for $300. Can't beat that.

Manda: $1k would have made me think long and hard about finding another doctor. Do you think your doctor was worth it though?

My surgeon had a $200 initial consult fee that he charges, but waives it if you attend a lap band seminar first. Then his normal fee for the surgery, $5,000, includes the first year of adjustments, regardless of how many.

I paid cash for my surgery as it was not covered by my insurance. It is worth every single penny. Also, my surgeon does not accept insurance for WLS.

GavynsMum - It did make me pause. I looked at 3 different centers in my area. All had programs fees but I admit this was the highest. However, my insurance doesn't cover the nutritionist or the psychological consult so those two would run at least $500 by themselves. The program fees for the other two centers were less but didn't include these appointments. Also, all my appointments with my 6 month supervised diet is included and I get to see the doctor every time I go...not one of these meet the doc 2 weeks before surgery type places so I'm comfortable with it at this point. Access to the doc is very important to me and if I email him (had to ask a question about my husband's liquid diet), I get a response within a couple hours. Worth it to me.

BetsyB,

My mom recently went to the silver cross seminar and when she wanted to set the appointment to meet with the Dr. They wanted $5000 upfront and told her then she could recoup from her ins. even though ins is covering the whole thing. Needless to say, she hungup and went to Little Co of Mary.

On the other subject, I was banded at Day One Health in Chicago and there was never a fee. The psych and all pre-op testing was billed through ins. I never even paid a copay.