Question:
Requirements not met by insurance.
I am post op 2 years and doing fine. Live in Pgh. My daughter is considering Gastric bypass surgery and attended a seminar by Dr. Terracina this evening. She told me that the surgeon requires you to sign up for nutrition information and pamphlets and exercise information for an additional $395 (not covered by insurance) before they will attempt to get insurance coverage for your surgery. Has anyone else heard of this. My nutrition information was included with my surgery and my hospital has FREE seminars every month for patients to attend. Would be interested in hearing remarks if this is becoming a standard thing. SOUNDS FISHY TO ME. IT SOUNDS AS IF YOU HAVE TO PAY THE $395 FOR THEM TO EVEN CONSIDER YOU AS A CANDIDATE. WHAT HAPPENS IF YOU ARE DENIED...DO YOU LOSE YOUR $395. — Jo Ann S. (posted on August 16, 2005)
August 16, 2005
Sounds like gravy to me. Thank you, please drive through. I would suggest
checking out several surgeons in your area and find which suits your
daughter the best. Personally, 400 dollars for some nutrition &
exercise pamphlets screams 'in it for the buck', but hey...i've been wrong
before. Good luck to you! Rebecca
— RebeccaP
August 16, 2005
My nutrition classes were not included with surgery... We were told to pay
$200 after you were approved for surgery. They needed consults from
Pulmonary, Cardiac, Nutrition and Psych, but some how I got out of Psych.
Yes it sounds like they are trying to make money.
— dcox94
August 16, 2005
Jo Ann, when i started my journey to WLS earlier this summer i researched
alot of different clinics. The one here that i'm using requires a 500.00
surgical program fee. This covers the cost of all my post and pre-op
nutrition classes, appointments with the nutrionist and the cost of paying
someone to file with my insurance.
They have let me make payments on it and i have my appointment with the
surgeon on thursday. From what i have gathered from others this is
becoming pretty standard and some offices have made that fee as high as
1500.00.
If you think it sounds fishy check with your insurance company and get a
complete list of charges and what this fee covers.
— Tera P.
August 16, 2005
Well, the fact that they want the money up front would scare me. As you
said, what happens if you aren't approved? If you pay the money, do they
guarantee your approval, or would you pay nearly $400 for nothing? I had my
surgery last year at UPMC Magee and my nutritional support was included in
the package. I had an absolutely wonderful surgeon, who I adore, and had a
pre-operative nutritional consult, pulmonary eveluation, overnight sleep
study, and many post-op nutritional consults and follow-up exams. My
insurance covered this package and I think I wsa billed about $180 in
co-payments for all of it. And everyone at Magee was helpful and sensitive
to my needs. You may want to look into their bariatric program. My brother
and I have both successfully come through their program, (we each lost
150lbs)as have many of our friends. Best wishes for health and happiness
always.
— Donna F.
August 16, 2005
I had to pay that much also in the beginning!!
— blondieasis
August 16, 2005
My Dr. also required the nutritional counseling. My insurance company
required proof that I needed the surgery and I was serious about compliance
afterwards. And truthfully, you can be turned down for a variety of
reasons, not just because you didn't go to nutrition classes. My insurance
company didn't pay for the classes or the psych evaluation.
Good Luck. I don't think it's fishy at all. It's just being careful.
Just my opinion.
— CGKitty
August 16, 2005
Just my opinion - I don't pay any repair person up front, most service
related things you don't pay up front. This is your life and health and I
agree it's important that the medical profession gets paid, but I have to
really wonder if it's YOUR best interests that are most important when the
money is demanded up front and above the cost of insurance.
— Nut Picker
August 16, 2005
I also attended his seminar in Newport News, VA. I decided on a team of
surgeons from Norfolk Surgical Group in Norfolk, due to sheer
professionalism. But I also had to pay the fee. The only difference is Dr.
Terracina does not require the money until AFTER you are approved. NSG
required it beforehand, but then again I feel like I'm getting better
service.
— [Deactivated Member]
August 17, 2005
I had to pay a $20 nonrefundable fee to go to the seminar at the hospital
here in Albany, NY. $20 is doable but $395. is a bit much.
— luvsmyfids
August 17, 2005
Hi, I had to pay 250 for the Physical Therapist (3 visits in 3 months) and
260 for the Nutritist(2 office visits 1 phone call) and 200 for the Drs
office to do the paper work.
And I pay 20 per visit. My insurance company required the PT and Nutritist
for the 3 month period because my PCPs records didn't suit them.
At first I thought this wasn't worth all this money. But my life is worth
it plus more. I want and need this surgery so what ever I have to pay is
going to be worth it.
I believe that all of us need to relize that we spend alot more on food
over a period of time that paying these fees can be looked at as taking
real care of our selves.
— tammymoll
August 17, 2005
Jo Ann, most surgeons do charge a "program fee" prior to
surgery. Some charge $3,500, $2,500 down to $200. The downside is if your
insurance denies the claim you are out the money with no recourse. As for
the surgery decision, I strongly recommend that you compare the adjustable
gastric lap-band versus the gastric bypass. Look at the long term results.
If your daughter is young and still wanting to have children are all
things to be asking yourself. Good luck, Malissa
— Malissa
August 17, 2005
Ok these others are right some surgeons do charge u a fee up front the
surgeon I work for does not everything we charge for is covered by
insurance.....as long as your insurance covers and pays for
bariatrics...pre op post op and the surgery and that is easy to find out
just call your ins. company some have exclusions that your BMI has to be 35
or above with other co-morbid conditions and 40 or above with or without co
morbid conditions...depends on your ins. and it varys by company and
state...so check yours and find out what do u have to do to meet your plans
requirements have them to fax, email or mail you a copy of your
requirements...
— j s
August 17, 2005
A few areas surgeons in NJ charge an after-care program fee. My surgeon
charges $1200, which includes a nutrionist that is at the bi-weekly mtgs
(which all three surgeons attend to answer questions), e-mailed responses
within 24 hrs, which is wonderful, 4 support group gatherings, like x-mas
holiday party w/guest, halloween, summer b'que, and a fashion show. This
fee is required, not covered by insurance, once surgery is approved and a
WLS date is set, the fee is due. I didn't like paying the fee, however, my
surgeon's office is very pro-active with the health of their patients and
has an outstanding support system via 2 mtgs a month and an online chat
board. I believe they may be on their way to becomig a center of excellence
for baratric surgery. Just wanted to share my experience. Wendy
275/175/150 3/15/04
— SJWendy
August 17, 2005
I am in St. Louis and I had to go through a screening process which
included seeing a dietian and a behaviorist. The cost was $425 and it was
non-refundable. I was approved and am now 9 weeks out of surgery. I feel
it was well worth the pre-screening and money.
— Christina F.
August 17, 2005
Yes that happened to me but for over a thousand bucks. Then they dragged
there feet till my ins ran out. So I asked for my deposit back and they
said it was non-refundable. That was 2yrs ago. I found another program in
my town that includes everything. My surgery is going to be done on the 22
of this month. So far I have had no out of pocket expenses. J Camara
— jani204
September 1, 2005
I would shop around for another surgeon. I did not pay a dime up front.
Once the surgery was approved the insurance paid for all the nutritional
counseling and support and information was free.
— catleth
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