Strange Letter from Chrias

Did anyone else get this letter from Chrias that I received August 31 2006? August 23,2006 Dear Patient: We are writing you today about your next scheduled visit with us.For some time we have been attempting to work with your insurance carrier to improve their reimbursement to us for bariatric surgery. Unfortunately, our efforts were unsuccessful.As a result, we found it necessary to notify them that, as of September 1,2006, we would no longer be a participating provider for bariatric surgery services. It has always been our intent to continue to be a participating provider with them for all other services, including such things as post-operative care of our bariatric surgery patients.We have enclosed a detailed explanation of the situation and we encourage you to read it thoroughly.If your insurance company considers your ongoing care as an in-network benefit with a participating provider, you will not be affected by these actions. If however, they consider us to be out-of-network for your ongoing care, you will be responsible for paying us for your visit. Our usual and customary charge for the typical follow-up visit is $125.00. You should be prepared to pay that amount at the time of your visit. As we indicate in the attachment, we will assist you in every way possible to recover payment for any insurance benefits you are entitled to under your policy. We regret that your insurance company has been unwilling to resolve this matter satisfactorily. Sincerely yours, Christiana Institute of Advanced Surgery August, 2006 To our current bariatric surgery patients: Until now, Christiana Institute of Advanced Surgery has been a participating provider with Blue Cross Blue Shield of Delaware, Amerihealth/Independence Blue Cross, Coventry and Aetna in performing bariatric surgery.This means we accepted their fee schedule allowance as payment in full for a patient's bariatric surgery.As of September 1,2006, Christiana Institute of Advanced Surgery will no longer be a participating provider with those insurance companies in performing bariatric surgery.On that same date, we will begin billing our bariatric surgery services under the name Weight Loss Center of Delaware as an "out of network" provider.Although our intent was for Christiana Institute of Advanced Surgery to continue to provide all other post-operative services as a participating provider, we may or may not be permitted to do so by your insurance company. Blue Cross Blue Shield, for example, has informed us that they will not allow this. The other insurance companies listed above have not indicated how they intend to treat these services.If we are permitted to provide these services as a participating provider, nothing should change for you. If you have a co-payment provision, it will apply, and we would accept the benefit the insurer allows as payment in full for our service.If we are not permitted to provide these services as a participating provider, it is uncertain at this time whether they will pay an "out of network" benefit for any of these services.This means that the patient--you, will be responsible for paying our fees in full. If your insurance company will pay an "out of network" benefit, your out of pocket cost will be reduced, but you will be responsible for our full fee, regardless of whether you receive an out of network benefit.Why has Christiana Institute of Advanced Surgery taken this action?Simply put, the amount the insurance companies have been willing to pay for bariatric surgery is too low. Here are a few of the reasons we feel this way: ? Our costs for doing bariatric surgery are significantly greater than for other types of surgeries. For example, professional liability insurance ("malpractice insurance") premiums are higher for bariatric surgeons than for general surgeons. Also, our surgical scheduler is required spend more time coordinating the medical clearances of a number of specialists, in addition to the hospital staff. In addition, there is much more correspondence required between your insurance carrier and CHRIAS to obtain approval for your surgery than for other procedures. This means higher staffing costs. ? The amount of work required of the surgeon is also significantly greater than for other types of surgeries. For example, the typical surgical fee includes the requirement that we provide 90 days of post-operative care for no additional charge. For most procedures, this involves a minimal number of post-operative visits. For bariatric surgery patients, your follow-up regimen includes at least three office follow-up visits, each of which is substantially more involved than a post-op visit for most other surgeries. ? The insurance company saves money as a result of bariatric surgery being done, but does not share that savings with the surgeon responsible for those savings. It was never our intention to withdraw our participating provider status. Needless to say, this action was not taken without extensive thought being given. We made a good faith effort to negotiate with the insurance companies to avoid the necessity of this step. As an example, one of the insurance companies above recently notified us they intended to reduce our reimbursement for gastric by-pass surgery by almost 34%! Even before that notice, we were attempting to negotiate with them for an increase in our reimbursement for Lap-Band surgery because we felt that the amount they have been willing to pay for this procedure is too low. As another example, we have been presenting our case to another of the companies above for over two years, without success. We are willing to accept participating provider status again. How does this affect you? As we indicated above, we are not completely certain at this time. If we are permitted to provide these services as a participating provider, nothing should change for you. If we are not permitted to provide these services as a participating provider, you may or may not receive an "out of network benefit for any of these services. Regardless of which of these possibilities exist, you can be certain that we will assist you in every way possible to recover payment for any insurance benefits you are entitled to under your policy. Christiana Institute of Advanced Surgery will continue to bill your insurance company as we have in the past for your post-operative and follow-up care. If they will pay an "out of network" benefit, your out of pocket cost will be reduced, but, as we indicated earlier, you will be responsible for our full fee, regardless of whether you receive an out of network benefit.

No Diane, I have not received this very concerning letter. Wonder what gives??? Insurance Co's must be a bear to get $$ out of. Then again it's all about the $$ isn't it? Looks like it's gonna get harder and costlier for the pre-op's. Then again it'll cost us post-op's more for follow-up's. Gosh I wonder what it'll cost us to stay healthy? I wonder if we should bombard our insurance co's with our concerns? I hate to assume anything. Any other thoughts? Elissa

Diane, I did not receive this letter yet....but this is a concern to me. I had my consultation a few weeks ago and I'm in the process of having all my clearances done so I can be eligible for surgery. I have Blue Cross Blue Shield PPO Personal Choice. I will not have the surgery through them if they are not on my provider list. I will be on the phone with my insurance company first thing Tuesday morning. Thanks for the heads up. Lisa

Well I am up the creek with out a paddle!!! I have a Lap Band!!!! I need to get adjustments. I can't afford to pay $125.00 just to get on the scale!! Right before I had my surgery there was an issue between Chiras and Christiana Hospital, They were in dispute with them, and I was told they were no longer going to perform surgery there. That was after I had spent all that money at PRMI. I did end up having it done at Christiana, however it did add to my anxiety. I understand that they have differences, hospital and insurance companies, however they don't need to pull their patients into their battles. I guess it is all about the money!!! I could never treat people that way!!! I guess I will let my band rot inside of me. I thought my Dr. cared. I guess I was wrong

I did recieve this same letter. I am very upset by it. I was due a three month post op in August which is normally included in my surgey and has no co pay. But Dr Wynn was not going to be available and I am not scheduled to go in until later this month. So does that mean that I will have to pay 125.00 because she was on vacation? I will be making several phone calls tuesday, because techinically this visit is already paid for. I am also concerned with what this means further down the road. What if I were to start to have a problem, will I be able to see her? It not like I can just call someone else and see them instead. If anyone else has any input on this I would love to hear it. Jen

I have checked with a few of my friends that are pre op none of them have received the letter. only the people I know that are post op got the letters. could that be because Chrias is afraid that the pre-op's will go else where?? and that they know that the post-op's are stuck, because no other surgeons will want to fallow up with us? I don't like being the pawn of their little game. I know that some of the staff at Chrias reads this post. I also know that Chrias won't always be the only game in town! I have a feeling this one might back fire on them.

This is bull. They are still making quite a profit from the insurance companies listed above. They wouldn't work with them at all if they were taking a loss or even breaking even. I can't imagine the type of money CHRIAS must be raking in. I am having my surgery on Sept 19th. When I first had my consult back in Dec, I decided to go with Dr. Wynn because I liked her and their practice felt more like a surgeon's office than a WLS chop-shop. Now they will be billing as The Weight Loss Center of Delaware? I had my post-op last week and couldn't even see Dr. Wynn, so I had to meet with Dr. Peters. He was nice and all, but it would have been nice to actually speak with MY surgeon before the day I get cut open. They said she was on vacation and/or booked up til the day of my surgery. I'm wondering why I just didn't go with Barix Clinics. At least they are easier to contact (i.e. actually answer the phone). They don't even try to hide the fact that they are a business, but at least the customer service seemed a lot better. I don't even have one of the insurance companies they are having problems with, but this still concerns me. First hospital squabbles, now this...I'm sure my insur comany is next...maybe my hospital too. Ahhh, this is so frustrating. The person who said they shouldn't be bringing their patients into their contract/finance battles is 100% right! Why do I think that they would actually prefer to bill as out-of-network? They'd probably get just as much from the insurance co, and we the patients would make up the difference in what they "bill" out-of-pocket. For example, if you're lucky enough to have out-of-network benefits that pay 70%, they can bill $25,000 for a surgery. The insur company would pay $17500. The patient would pay $7500. How much better is that for them, than to be a participating provider and only be allowed to bill the patient a co-pay and the insur company a max of $10,000 (or whatever rate they negotiate with them). And as for the higher staffing cost...my parents have had major surgeries (of the heart, lungs, etc., much more involved than the LapBand I'm having placed) that required just as much post-op care, if not more. They never had to handle so much paperwork themselves, or make so many calls, or "coordinate" their own surgeries as I have done (and I can't be the only one). I get that there is more paperwork involved, but please! Sorry for venting so much. This just makes me really angry. I'm sick of every medical practice becoming just about the money...and here I sit, a couple weeks from surgery, and I can't get a call-back regarding whether or not they have all my clearances, since the receptionist at Dr. Bianci's office--where I must go for a final check-up at my own expense, even though I have a perfectly capable PCP my insurance would pay for--refuses to schedule me because they don't even know who I am. I wish I had all my clearances, I would fax them myself. Every day I call and they still don't have them...and I'm only having surgery in what, 2 weeks. No big deal. I've got some major thinking to do...and some research into other doctors around. I did that once and made up my mind. This letter makes me re-think quite a bit. Surely CHRIAS is only able to do this since they are the only bariatric surgeons in Northern DE. I think some local competition would be the best thing for them.

I just heard about this from a friend. I did not receive the letter, but I'm only 2 weeks post-op. I was in the office on Aug 31 and they didn't mention a thing. They even said I didn't have a co-pay for 3 months as part of the surgical follow-up. You would have thought they would have mentioned that beyond that I would be responsible for the fees. I really concerned considering I have BC/BS and a lap band which I need follow-ups. I think they need to fix this problem with the insurance company or I'm sure we can band together and do something about this. They can't lure us into surgery and then tell us our post-up care is not covered. This doesn't sound legal or ethically correct. I'm sure they're just trying to put us in the middle so we'll bombard the insurance companies with our complaints and then they'll pay more to shut us up. This wasn't my problem and I don't think they should make it mine now. I need the follow-up care and they need to make sure it happens without me going broke.

I guess time will tell for all of us. I understand that for ech of us this is very stressful. However, they are running a business. I am sure we do not understand all of the intricascies involved with running the practice. With that said...Don't chop off my head ok! I too am affected by this I have BCBS of Delaware and I have switched jobs and will have coventry. Looks like I am screwed as well. Guess I will not be able to honeor the contract that said I would have follwo up visits with them. I wonder if this goes for future scopes of my stomach for ulcers that have developed since my surgery? Any ides where I can go for this type of procedure? The more I think about it I do not know who is in a more precarious position those that are pre op or post op. On one hands future hopes might be dashed and on the other hand where do we go for expert follow up care? With regards tot he practice, I do not feel this will affect them in the short term but further down teh road. Best of luck to everyone! Gary

Hi all: I am usually on the Lap Band Board but not the Delaware Board. I had my surgery in July and my first fill in August and also have BSBC of Delaware. I have received no such letter. Do any of you know if this letter is going out to both HMO and PPO patients? Thanks, Susan