ARRGGGHHHHH

I went to see Dr. Irgau yesterday. First of all I spent 3 hours waiting AFTER my appt time to actually see him. But anyway. He was very nice and apologetic and gave me all the information that he could now. He also told me that I was well informed. When I got home I started reading all those colorful pieces of paper and came to find out that the lifestyle classes are $1200.00 up front. jesus mary and joseph! Has anyone had their insurance company pay for these? What is up with this? I can see pay as you go, but for the love of god, where should I get all of this money in one shot? Sorry for the ******g and moaning, but I was in a bit of shock! haha. Thanks for "listening".

That's only if you're having your surgery at Christiana. If you have your surgery at St. Francis, it's about $600-800 I think. Look back at some posts from last month. Someone went into the details about St. Francis back then. I got a breakdown of what the $1200 included then tried to get BCBS DE PPO to pay for some of it, but all were denied. The $1200 includes: Nurse Practitioner Psychologist Dietition (they might tell you it doesn't cover this appt, but I made a fuss and they included it) 6 Life Skills classes Endocrinolocist-final physical for clearance (also make a fuss about this one if they try to say it's not included) 5 years worth of group meetings held at PMRI I have found out that the more of a fuss you make, the more they'll try to accommodate you. I paid $600 on the first visit and the rest on the last visit. On top of all of this, I've had to have all of the problems that they found taken care of. I'm in about $2000 with all of the specialist co-pays and prescriptions now and my surgery isn't till 7/13. I think they want to make sure you REALLY want to have this surgery, and that you're going to be willing to completely change your lifestyle. There have been people who walked out when they found out that they have to stick with the program for the rest of their life, not just till they loose the weight. They believe that if you're willing and determined enough to pay the $1200, then you're more likely to stick with the program. Hope this helps. Dee

Thanks Dee! I think I will throw a fit with Blue Cross and see what they can do for me. I was also going to call Christiana and see what I can do with them. I am willing to pay the $1200 I just don't have it all in one shot. haha How long did it take to complete these appts?

Well, let's see, went to my 1st consult with Irgau on March 31st (waited 1 1/2 hours after appt time, but refused to leave cause I had to wait 6 weeks to get it!). Saw Ishmael (pulminologist) on 4/13 (he recommended sleep study because I snore) and had 1st life skill class that night. Had my EGD on 4/15 with Modi (he found damage from GERD and put me on prevacid). Saw Pastore (cardiologist) on 4/18, passed but he recommended me to my PCP for high BP. Went to PMRI on 4/19 for Nurse Pract (also recommended seeing PCP about BP, got blood work orders to be done 2 weeks prior to final physical appt) & psychologist (recommended extra appt with dietition because she felt that I "hadn't done enough in the past year", but I failed to tell her about taking laxatives (I was embarrassed, don't you be if you've done anything stupid like that, just tell everything). 2nd Life skill class on 4/20 & sleep study that night in Middletown (I highly recommend this facility, easy to get appt, and Steve & Dave are extremely nice and helpful) they concluded that yes I do have apnea. Went to my PCP on 4/25 to have BP taken care of (he recommended that I track my BP every day & have bloodwork done). 4/27 Life skills. 4/29 Went to GYN for chronic menstral problems (he recommended ultrasound). 5/4 back to Ishmael for Pulminary Function Test (Passed) & life skills. 5/5 Papastavros for ultrasound. 5/9 back to PCP for bloodwork review & medication (he put me on Diovan). 5/11 Life skills class & 2nd sleep study in Middletown with cpap machine. 5/13 back to GYN for ultrasound review (something showed up so I had to have a biopsy, ouch!!!). 5/16 PMRI for dietition appt (passed) 5/18 Final life skills class (included a test on what we learned and final weigh in. You absolutely MUST NOT gain any weight. You can loose or stary the same but not gain). 5/23 Lawton (Podiatrist, diagnosed with plantar faschitas, gave me cortizone injections in my heel & an arch brace) had to get foot xrayed before and bring xray with me & PMRI for final appt with medical doc (endincronologist) passed but they hadn't gotten final report from Ishmael (pulminologist). Come to find out that Ishmael's staff hadn't called to set up appt to review sleep study & order cpap machine. 5/25 back to GYN for biopsy review (not cancer, just infection, got 2 prescriptions, 1 hormone therapy to get periods synched back up & 1 for infection). 5/26 back to Ishmael for sleep study review (have SEVERE apnea, told he will pass me after I get my machine and that will be ordered that day and to expect mediquip to call me the next day). Waited over a week for phone call from mediquip, nothing. Called Misty at Irgau's office (my Hero), she called Ishmael's office and made them order it while she was on the phone. Got phone call on 6/6 from mediquip telling me that Resp Therapist will call that week for appt to set up machine. 6/10 Resp Therapist called & set up appt & back to GYN for check-up (everything fine so far, still on monthly hormone therapy). 6/13 8pm Resp Therapist brought cpap finally!. 6/16 back to Lawton (Podiatrist) to check cortizone progress on foot. Still having some pain, but she recommended that I get 4 weeks of physical therapy to try to reduce pain so I'll be able to walk alot after my surgery. I now have to call to get the therapy & I go back to my PCP to see how BP meds are working. My pre-op appt is on 6/23 & I have to call Christiana Care back today cause they left me a message last night. My surgery is scheduled for July 13th (they originally wanted me in on the 21st but I'm going on vacation on the 26th so I pushed it back a couple of weeks) and I haven't gotten the word that my insurance has approved it yet so I'm going to call Misty this afternoon and get an update. So, for me it will be 15 weeks from start to finish (it would've been 12 if not for my VC). I am very determined and have extremely supportive and understanding bosses. My hubby had been wonderful too. He even went to a support group meeting with me. I haven't told anyone else about my surgery except for my Hubby, kids, and a couple of close friends (work too because I had to). I'll wait till I get my approval letter from the insurance co before I tell anyone else. That's it in a nutshell! Dee

Jennifer, I don't know what insurance you have, but I have Aetna, and I only had to pay $575 up front. I then had to pay my regular $30 copay for each of the specialist visits, except for the psycologist. I had to pay the full $155 for her because she was out of network for my insurance. The $575 included the LifeSkills class, which is mandatory for clearance, and the support group meetings for 3 years. I was not happy about what I had to pay either, but I would do it all over again ten times over to have the surgery. I'll be 8 weeks out on Monday and I'm already down 60 pounds. My advice would be to contact PMRI, I believe the person to contact there is Judy, she's the insurance coordinator. She'll contact your insurance company to determine what they will pay for and she'll call you back with the actual amount you'll need up front. Don't get discouraged, you'll get really valuable information out of the classes and support groups, and the appointments with the specialists are invaluable. Good luck! Joni

I talked to Nicki at Dr. I's office. She told me to call Judy. Judy said the Blue Cross does not cover anything. I am going to call BCBS and b**ch. Maybe I can get something done. Judy said I have to have $600 up front and the rest at the end. I will do whatever I have to do, but I am not rich by any means. I am trying to get a loan, but that could be VERY difficult as my health problems have in turn caused credit problems. SUCKY! Cross your fingers for me.

oh sweetie i am so sorry you have to go through this i pray that everything will go smoothly for you.i had to pay 575.00 bummer it was hard getting but i didn't stop i said even if i have to sit on a corner with a tin cup and have my story told to the world i'm gonna get this done if it's the last thing i do.lol my thoughts and prayers are with you sweetie.your friend bonnie

Hello Ladies, PMRI..... Lets just say this... BCBS if your plan includes it will cover most of your appointments at PMRI. PMRI will not send your bills to them (BSBC). I was one of the people who had the surgery done before the up front payment. When I called BCBS, they were suprise that PMRI was not submitting the paperwork since THEY ARE IN NETWORK!!! Please note: You should contact your insurance comapny and find out that they cover in your plan. INSIST that PMRI send the paperwork. I'm in the process of getting hundreds $$$$ back in over payments! Another thing: They (PMRI) charges you full appointment prices. Not BCBS contracted rates. They are in NETWORK and therefore should take your co-payment. Stick to your guns. They (I feel) prey on people because we have no choice. We have no other place to go.... but now there is a choice. I am not learnt on St. F's program. You may want to look at it. Please note: The support groups at PMRI are a good thing however, the subjects of the meetings repeat. 3 years is what you are paying for.... I had surgery in Jan and I have only gone to one.... Thank goodness I only have to pay when I do go.... Best wishes!!

I had PMRI give me a breakdown of the services that I paid for with my $1200. I then sent each one to BCBS DE (PPO). They denied every one. The endocrinologist was not included, but PMRI submitted for that one themselves and it was covered. What was not covered was: Nurse Pract., Psychologist, Life Skills, Dietition, Nutritionist. BCBS's denial stated that the diagnosis (obesity) was not covered, yet they cover the surgery. Am I crazy, or are we having this surgery because of an obesity diagnosis? I would think that at least the Nurse & Psychologist appts would be covered. Anyone else out there have the PPO and get some of their money pack from them? Dee

Here is what i know, St. Francis is $400.00 that covers the RN you will see for basic info, about your history and the surgery (maryellen sparks) 2 nutritionist appts, and i recently learned that it also covers follow ups with the nutritionist after surgery.... also the support meetings they have there are free. Thats who i chose, mostly b/c of the cost, however one downfall they are bit scattered brained (at times)..LOL hope this helps -Christina