I have wanted to have the Lap Band for 3 years. However the place where I worked was self insured and did not cover the procedure. So when I got this new job, I was relly happy to find out that they did cover it.

I went to Dr. SPeigle's office on Saturday for a consultation, they had a sign that said he was no longer taking UHC for fills, nothing about the surgery. Well they called me yesterday and said that I was approved, however since he was no longer in net work I would have to pay him $4500.00 (that may as well have been the $15,000.00 cash price).

When I got home I immediatly came here to ask for help, however I found a message from back in March, about asking UHC about a gap exception. They said they would pay his bills at in-network prices. Well when I called his office today to talk about it, I was told that he was not taking any UHC in network coverage. That was when I got mad. How can a doctor refuse a patient when they have insurance coverage.

Can anyone let me know if there are any doctors in Houston that is taking the gap exception from UHC?

I really want to have this procedure, so any :help: would appreciated :kiss2:

Also does anyone know the doctors are getting out of UHC, they are one of the largest health care providers?

Thank you for that wisdom shackdog. I think the ones of us affected have done that. It is difficult to redo the paperwork and wait again for approval after we had already done that. I still don't know if my surgery date will hold because UHC hasn't responded to the new doctor. I got the call on a Friday evening and I was on the phone on Monday. I had a new appointment on Friday and UHC was in the loop the whole time. It is very frustrating to have come so far, but this is just a setback. All of us will get through it and move on. It's the waiting that is driving us crazy and the reason we are put in this position that makes it frustrating.

OK, GREAT, I guess I am just missing her

Dr. Spiegel is not refusing a patient, he is refusing their insurance........PLUS insurance companies ARE EXTREMELY hard to work with when your a doctor, especially UHC. They really screwed me over and I paid CASH money for the surgery, and its worth EVERY PENNY

UHC had a good reputation in general for support of WLS. Some companies have exclusions, but UHC has been very supportive. In fact, Dr. Spiegel and his staff told all of us at one of the seminars that UHC was one of the best to have.

I think the problem was that some of the doctors are not willing to pay what UHC wants to contract to pay. They want more. When they can't get an agreement then they sever their relationship. Dr. Spivak was first, followed now by Dr. Spiegel.

Paying cash is an option for some, but for those of us that have insurance that will pay, it just seems silly not to find a doctor that covers it. Of course, I also want a good doctor. Maybe I should have hurried up and had the surgery and cancelled our cruise, but I didn't think that was fair to DH or to me.

OH well, hopefully it will all work out. I found a great doctor, but still waiting for UHC to reapprove me.

Mini Me, Thanks for your kind thoughts. I went to see Dr. Turnquest this afternoon. I really liked him, I mean he actually sat down and talked to me. Made me feel like he really cares for me and not the money. Their office will be calling UHC tomorrow and hopefully I will be getting a call in the afternoon, I will get back with you this weekend.

Ok Dr Speigel did my lap band July 28, 2005 and I do have UHC

Has anyone changed to an "in network doctor" in the houston area for fills or what not?????

easy answer, Just find another Doc

Acutally its not that easy i was in the same situation, and now no other doctors takes outside patients and there fills are $150 to 299 each time

My saga continues, but its almost at the end. Short story: I called Dr. Spiegel's office today to cancel the surgery I still had pending with him. I made this call after I was told that my UHC approval had been transferred to Dr. St. Laurent. Spiegel's office was very upset and said that they didn't want me to leave them. Bottom Line: After many phone calls, nervous collapse (mine), Dr. Spiegel is doing my surgery for out of pocket of $2,800. No additional to surgi center. He is doing it on Tuesday as scheduled with the other doctor so I don't have to wait.

I feel like I've been through the wringer. I liked the other doctor, but Dr. Spiegel certainly has done more. Spiegel's office also told me that the rest of the year I wouldn't have to pay anything since my follow-up and first fill were included, and future fills would be paid for since I met my deductible. In other words, they would take what the insurance gave them. I see them in the morning so I'll get this in writing.

I feel like I've been to a fire sale and the sale was my body parts!!!!

Well congrats, and I hope all goes well for you.

Nothing to do with Dr. Speigel but......Dr. Spivak did my band 9/16/05, my husbands 1/25/06........my last fill was 1/25 and my husbands was 5/3/06. We have UHC (through SBC/AT&T) and knock on wood have had no problems......Dr. S did our fills at the Surgericenter and all we paid was our $20 copay. Best of luck to everyone fighting this mess, reading all your posts makes me realize how lucky we had it. From my consult to OR table was about 3 weeks, DH had his consult on a Friday, on Monday had his UGI and on Wed. got his band........made my head spin!

Spiegel's office also told me that the rest of the year I wouldn't have to pay anything since my follow-up and first fill were included, and future fills would be paid for since I met my deductible.

What happens if you have slippage or a need for additional surgery. Since he's not taking UHC, how would that monetarily effect you? I am curious because I recently had a scare and if I hadn't been able to make it an additional day to get into Dr. Speigel...I would have had to go to 12 Oaks for him to help me. Since he's no longer with UHC, would his costs been out of my pocket?

I'd love to stay with him, but after that scare...I realized my family can't take a financial hit like that from an emergency or additional surgery with a doctor who won't take UHC.

food for thought. Susan

Additional surgery would fall under the 60/40 out of network costs. Remember, once you meet your out of network deductible that split takes over. My out of pocket max is $6,000. Once I paid that I wouldn't have to pay anymore. Look at it like that. The most you would have to pay is your max out of network.

That could happen with any doctor. One of my specialist, not lapband related, is out of network. I had to pay the out of network deductible.

I wouldn't worry about it too much.

Isn't that Max out of pocket per year? So what if there is a problem next year? or what about your fills next year? Just asking....

We are also on UHC...but had our surgery March 24th...Dr. Spiegels office has been very helpful to us...We now have to pay for our fills ourselves...I wish he would still accept our insurance, but I'm not changing doctors...Since he no longer takes UHC his office has become more relaxed and makes the fill a more plesant experience...maybe he was just too busy before...

there was a post today that speigel is taking UHC again...