Attention Mercycare Insurance clients - accepting out of network surgeons

As you are aware Mercy care does not have a surgeon contracted with them right now.  Dr. Fang no longer accepts this insurance.  While they search for a new surgeon they are accepting Dr. Robin Blackstone - 480-391-3885 or Dr. Steven Simon 602-264-0910.  You must be referred by your PCP to either surgeon.  This is really exciting for those of us worried about making the cuttoff Dr. Fang set as end of July.  Just wanted to pass the news along.  Thanks, Melissa

So true - But Blackstone has a 8 month waiting list ??

I called Dr. Blackstone's office and spoke with the operator.  She said no waiting list but it maybe  a little longer of a wait from approval to surgery date.  So I left a message for the surgery scheduler to find out the time frame and will post once I hear back. Thanks, Meliss a

 

Cool Melissa, 

You really did a lot of foot work....  Is it true Mercy Care doesn't pay for lapband?  My son was referred by his endocrinologist for WLS.  I'd rather he do the lapband than the RNY.  Thanks for the info.

Candy 

 

I am actually surprised that Blackstone's office is taking Mercy care, since I know they discontinued Medicare earlier this year.  Also, Blackstone's office does have a new surgeon Dr. Sprunger, I don't know if Mercy care would accept him as well since they are part of the same practice.  He has a shorter wait time for surgery. Rebecca

When I was in private practice many insurance companies told their insured they could come to me but I didn't have an arrangement for them to come.  When the company attempted to make that arrangement some reimbursements did not fit in my clinical financial plan.  (Read:  they wanted to pay me less than I paid my providers).  I have NO idea if this is what is happening with you, but I would want to make sure Blackstone and Simon are on board with this alternate relationship with your funding source.  I only wish you the best and I personally have a WONDERFUL story with my surgeon working with my funding source and being willing to take the offered reimbursement.  LET ME TELL YOU, HE SURE DIDN'T NEED TO AGREE but he was that willing to help me.  Anyway, my experience in the medical world of insurance companies may have NO bearing on this story.  Just make sure that whomever you choose to be your surgeon is aware and in agreement to what your insurance company is telling you.   I can't wait for you to post that you have a date and all this ICKY, YUCKY insurance stuff is behind you!!

Update - Dr. Blackstone's office has told me they did speak with Mercycare about an arrangement but they choose not to proceed.  Not sure why my insurance told me today that I could go to Blackstone.  They don't seem to be very on the ball. In reponse to the question about which type of surgery mercycare will pay for.  Only the RNY is covered at this time, they feel the lap is to new and experimental.  Government insurance, very behind the times!

AHCCCS sets the policy and reimbursement. As of 2007, they only provide reimbursement for surgical "gastric restrictive procedures" with or without bypass, and revision. I don't believe that the lap-band is considered a surgical procedure, I think it is an implant, which is why not considered surgical. Reimbursement rates are 1200-1800 for the surgery, and probably not more than 1200 per day hospitalization.