I have done most of my preops that are necessary, but my surgery was pushed back because my insurance requires a 6 month supervised diet. My plan is to be banded in November, but I'm wondering if I should find a new Dr.

The reason I'm considering this is I remember signing a paper that said I would pay a huge sum of money prior to surgery (I think around $2,500) not covered by insurance- for program fees or after surgery care.

Will I end up paying that even if I found someone else?

My Dr. now is Dr. R. Pinnar in VA. Does anyone have any recommendations?

The surgeon i talk to today actually said they do give you a fuzzy robe and like let you put your feet in those foot massage machine. He said they try to make it like a spa experience apparently and that it keept patients from getting too nervous before surgery...idk it might be nice?

Nice.

For the couple of thousand bucks these clowns want for the "program fee", I could get my OWN custom-tailored fuzzy robe, a personal chef, and a couple of Hookers on call to take care of my post-surgical "needs".

I understand the "spa-like" experience. That would be nice, but for many, many people the WLS issue is one of SAVING THEIR LIVES, not having their toenails painted and knuckles buffed. And, that extra "program fee" PRECLUDES the possibility of many people being able to have/afford this life-saving/life changing surgery.

No, it's all a bunch of BS; just another way for these greedy scum-suckers to squeeze some more blood out the system.

And those who PAY the program fees are complicit, to a certain degree; every person who accepts these "fees" are encouraging the act of charging them. Eventually, ALL the Doctors will see that they can extract THAT much more money from the patients, and it will become the standard. And as a result, there will be people who really need the surgery that will not be able to afford it.

It's a bad situation, and it makes me sick.

:wub:

HH

I just called to see what the program fee was for and they said it covered 1 year of follow up nutritional appointments which they do not bill insurance for.

I've been trying to research other Docs and it just seems such a pain to switch. Maybe it's worth the $2500 at this point....or maybe not.

I don't see how they can charge that by law they must except what a insurance company pays them. After Surgery Care WTF that is covered by insurance. I would ask what that covers. I had to pay a $200 dollar program fee and the covered the support meetings, reading material and even a event for lap banders. But 2500 that is just ridiculous. I don't see how they can get away with that. What would the insurance company not pay that would justifiy 2500?

If it is for the nutritionist then tell them you will see one that accepts your insurance. I would call and tell them that you can not afford an additional $2500 on top of your portion of the insurance. They can not tell you which nutritionist or shrink to see- they set up these "buddy" systems that they direct traffic to so and so for the psyh evaluation or nutritionist - if they have a nutritionist on staff then it should be billed to your insurance. If they don't like the amount they get reimbursed from that then tough crap (hint to doctor, negotiate your contract better) Legally if they accept ur insurance and the person is on their staff they have to accept what your insurance pays less copays and deductibles.

If you need more help with this send me a private message with your email and I can try to help you out.

I run 4 medical facilities and am familiar with insurance.

Evie is correct.

These doctors have a "network" in which they "feed" each other, and YOU end up paying the bill.

I suspect that they might not take you if you DON'T pay the "Program Fee", but I would give it a shot.

It is HIGHWAY ROBBERY, though. They shouldn't be allowed to get away with it., and you SHOULD let your insurance company know that they are trying to soak up some extra cash outside of the system.

HH

Amen HH- DO NOT LET THEM KEEP DOING THIS.... it is in DIRECT violation of their contracts.... if you don't report them who will?

Good luck

Dr. Barry Greene is AWESOME and doesn't have that fee. I would go to him but I am self pay and he is $7k higher than where I am going in Michigan....tomorrow!.

Evie...did you know that Barry Greene is the same Doc who works for Dr. Pinnar in Reston? Unfortunately both offices (advanced wt loss surgery and advanced wt loss solutions) are out of network for insurance. I also know Dr. Pinnar charges around $350 for the first office visit which is not billable to insurance...not sure about Greene.

I'm still searching....looks like I will end up going to Baltimore to stay in network. I just haven't seen much on here about those Docs. I'm considering both Johns Hopkins and Univer. of Maryland med ctr. Does anyone have an input on either of those two locations?

I paid a $3500 "program fee" not covered by insurance. Don't do it. I regret it, got nothing for it, and am kicking myself. I rushed into it. Don't make the same mistake!!!

Evie...did you know that Barry Greene is the same Doc who works for Dr. Pinnar in Reston? Unfortunately both offices (advanced wt loss surgery and advanced wt loss solutions) are out of network for insurance. I also know Dr. Pinnar charges around $350 for the first office visit which is not billable to insurance...not sure about Greene.

I'm still searching....looks like I will end up going to Baltimore to stay in network. I just haven't seen much on here about those Docs. I'm considering both Johns Hopkins and Univer. of Maryland med ctr. Does anyone have an input on either of those two locations?

Belly-

I was banded at Johns Hopkins Bayview last month and had a very good experience. They do not charge a program fee -one of the reasons I went there. My insurance has covered everything except a few co-pays, so much less than $2500.

I know that U of M does not have a fee either, but they just started doing bands and I felt more comfortable at Hopkins.

Let me know if you have any questions.

Linda,

Did you find that the Dr.s were easily available there? How long did it take to get an appointment there typically? and how soon after insurance approval did you get your surgery done.

Lots of ?'s I know, but my 6 month diet will be done the end of Nov and I'm hoping to get surgery done in Dec. before my insurance starts over again in jan. So I need to find an available doc.

I love my surgeon BUT my insurance excludes weight loss surgeries so I was out-of-pocket 100%. His office staff got a copy of my insurance card to verify that I was not covered. So 2 weeks before surgery, I paid $15,000 in advance. I did all my pre-op testing through my PCP, who sent me to in-network providers and my insurance covered all of that.

Well, lo and behold, I two Explanations of Benefits from my insurance where the "central office" in Texas (not in my doctor's office in Georgia) filed two claims for a total of almost $1,000 -- after they'd been paid in advance in full by me! So after the first one, I called and demanded to talk to the person who did it. She said "oh, that was a mistake". But when it happened the second time, I called her back and told her that if she or anybody in their office filed another claim with my insurance that I would report them to the Georgia Insurance Commissioner for attempted fraud. Voila! no more claims, LOL.

Bottom line, they will take what they can get. And to me, it sounds like your doctor is grabbing for all he can get. It is DEFINITELY WORTH switching. Get copies of all your records and high-tail it to another physician.

Linda,

Did you find that the Dr.s were easily available there? How long did it take to get an appointment there typically? and how soon after insurance approval did you get your surgery done.

Lots of ?'s I know, but my 6 month diet will be done the end of Nov and I'm hoping to get surgery done in Dec. before my insurance starts over again in jan. So I need to find an available doc.

Belly,

I just sent you a PM.

Belly- I didn't know that Dr. Greene even had a partner- my surgeon that I work for refers a lot of patients to Dr. Greene- when he returns from vacation I will be informing him of this outrageous program fee and hopefully he will stop referring patients to him. Thanks for the heads up.

I have a friend who had bypass @ Johns Hopkins Bayview and a great success. I would recommend Johns Hopkins they have being doing WLS for a significant time now. I am sure if you get in soon and explain your situation they can get u a date for December.... the only issue I would be concerned about if your insurance knows you switch in January if they will drag their feet to get u authorization. I would call and ask them when u are finished your 6 month diet how long does it take them to review ur records and approve your surgery?

Good Luck and keep us posted!!