PMRI & $$ & St. Francis and money, etc - here is the down low on it

When you go to your first appt. with Irgau, et al, they give you a paper that states it costs 1200.00 up front for PMRI, HOWEVER, some insurances cover part of that. So before you get your panties bunched up, check on that. My insurance covered 580.00 and I had to pay the rest. I paid some cash and put a little on two different credit cards. It is that important to me to get the lap band. PMRI was losing money by not charging. I work for Christiana and that is pretty much a fact that Christiana has been losing money in a lot of different ways and they are trying to *plug* up the holes if you will. A lot of procedures that are done in the hospital are not getting properly charged and they are putting pressure on the nurses/clerks to put the charges in the computer. Also, going to PMRI is for your own GOOD. They are providing you with life saving information, not to mention they allow you the best opportunity to be a success. Irgau's office is not getting any money collected by PMRI. It is true St. Francis now has a program. The director is Dr. Bianci. My friend is having her bypass there on March 4th. She is one of the first couple of patients. She had to pay out to go there too, maybe somewhat less than what I paid, but when you figure in all the copays, etc it probably works out the same. She has BC/BS that allowed her to go to St. Francis. I hope this sheds some light on the subject. I know how disheartening it can feel to see that 1200.00 but don't sell yourself short by going somewhere that does not require an extensive work up before hand. In my opinion, that would be foolish. Good luck to all pre-ops and post-ops and just keep fighting the good fight and you WILL get where you want. I know it is a lot to with all the appts. and money, etc, but I think it is worth it! Pink dots

Personally I would have remortgaged my house, used credit or whatever I had to do to be able to use Dr.'s Irgau and Wynn as my surgeons. I'm in full agreement with the amount of pre-op appointments and clerances needed to obtain surgery, I feel it would be irresponsible to even consider this procedure without it. Having said all that, I'm not a fan of PMRI and the way changes are made there, the fact that they are the ones *****fuse to file certain paperwork for insurance while the insurance companies are still participating with them, the way it's next to impossible at times to make a simple appointment or have someone answer the phone, what used to be constant conflicting information and frequent staff changes. Ya do what ya gotta do to get where ya need to be in life and if PMRI was a stop on the way, so be it. I do continue to use it for the monthly support group, that's very important to me as I get good information from the people attending those meetings who tend to be very knowlegable and current in their information and ideas concerning long term health and wellness issues. I have also signed up for the womens seminar for women 6 months out and longer with Margaret Keenen. I've heard her speak several times. $55 dollars for that course but well worth it in my opinion as I feel that longer term post-ops need to be represented as well. I guess I have a mixed review on the whole thing. I just feel bad that it is probably going to be cost prohibitive for so many who desperately need to have this done and will be left with no other avenues to get where they need to be. Good luck to you and I'm interested in hearing more about the band. Linda

Linda, Thanks for your input on the seminar...I have been on the limb thinking about it for the last few days. I guess I will get down there tomorrow and sign up. Thanks again Debbie

Hi Debbie, I thought it was a good idea to do it too. Definitely get in tomorrow, they told me class size was limited and was half full when I signed up. I hope they do something for the men too, not fair to exclude them. Actually, can you think of any surgical issues that would pertain to just women? I can't, unless it would be obvious physical changes, or hormonal issues. Should be interesting. See you there! Linda

I considered taking this seminar but I signed up for the two classes "Stealth Health" and "Creative Ideas for Protein." Can't really swing all of them. Wish I could. I am hoping that the seminar is popular enough for PMRI to offer it again. Sounds like it will be! Those of you taking it this time, make sure you let us know what you thought of it, OK? Kit

I'm sure I'm going to start a feud, but IMHO - there is no way Christiana Hospital and PRMI are losing money. The mark up on ALL services provided is astonomical. ( My insurance was charged $240 for drugs from an emergency room visit.. this was for 2 tsp of amoxocillin) I'm sure they have to hound some people for payment, but then it goes to a collection agency. Most charges will get paid at some point. I don't blame PRMI for charging upfront, I don't know of any other services that do not do this.. can you see getting a pedicure then saying bill me?? LOL Just wanted to add my 2 cents, and also re-state what Pink said.. check into your own insurance coverage before thinking that you need to pay $1200. T

I pay for all my appointments at PMRI. It's not the dollars.. it's the 1200 up front that is hurting a lot of people. I'm paying as I go. It's much easier. Makes a big difference. Gigee

Funny you all should be talking about this topic... my insurance carrier (BCBS PPO of PA) called me today concerning PMRI. I've been submitting my PMRI receipts, after I paid up front for services. The first time it took nearly 6 months to get reimbursed, and lots of calls, copying and faxing on my part. It's a much shorter process with BCBS now since I know all the paperwork I have to send them up-front. And I have gotten reimbursed for a good portion of the $$$. (I had my surgery before the Life Skills class was a requirement so I am talking about the nutritionist and doc and nurse practitioner visits...) But anyway, back to the phone call today. It seems that BCBS was auditing accounts and brought to my attention that PMRI is a participating provider and I should only pay a $10.00 copay and not have to submit my own paperwork. They asked me why I did it that way. I explained to the BCBS rep that paying up front was how PMRI chose to handle it. The rep replied that PMRI was going to recieve written and verbal notification of their "responsibility" as a participating provider. Not that it will hel*****t?!? Just thought I'd let you know...and wondering if anyone else has been contacted by their insurance company about this...???

Ms. Kitty AGAIN! In telling you my experience, I forgot to say that I too have mixed feelings about how this issue is handled. I also agree that there are pros and cons to both sides. I pretty much agree with what everyone else has been saying. I think it is vitally important to be part of a comprehesive program both pre and post surgery. That's why I chose Dr. Iragu and his team. I do, however, think it is a big shame that the cost keeps rising, especially if or when it keeps someone from considering or having the surgery. As others have said, I would encourage anyone out there having a problem, to contact their insurance provider and see how much of it would or wouldn't be covered. Good luck everyone! Kit

You know, if we all thought about how much money we've spent on diets in our lifetime, $1200 is a piece of cake! And it ends here!!!!! Just felt like I had to say something....even though this fee was not the case 4 months ago! Think about it people - we're worth it!!! Maria P