$3k WOW! Never heard that before...

You better check with Rabkin's office again.  My mom had surgery with him (almost 3 years ago, policies may have changed) & after she got insurance approval, they told her about an additional amount for doctor's fees - an amount she didn't figure into her loan.  She ended up getting it, but it was about $3000 if I remember correctly.  

That being said, regardless, it's the best money you'll ever spend!

 Dr. Smith in Atlanta GA he charges $500 up front, if you "go with him" or not, you pay that before you even get to talk to the doctor on the phone, that is if you are out of town.

I have no idea if that also applies to in town people. 

Somewhere I read on this forum that Dr. Keshishian does this because he accepts so many different insurance plans. As a result, he is bound to accept what the insurance offers for the procedure, which is much less than he would get for self- payers. This "program fee" is a supplement that is not and cannot be billed to insurance. Please don't look at it as a "tip." The docs have to get paid for their hard work. Dr. K makes it so that MANY people can have this procedure utilizing insurance. I can't go with Dr. Rabkin, for example, because he requires an even larger fee up front- that MAY or may not get reimbursed. I can't remember how much but I don't even know how I can come up with $4000 for Dr. K (not the $3,000 you quoted) so I just forgot about the amount. If you want the best, you have to pay. You really do get what you pay for. I'm taking out a loan because I am not going to fool around with this. I am also too far away to utilize the support groups, but I will be happy to pay (should my @#$% referral ever go through)so that I can have this surgery! Go to dssurgery.com and read about everything. It's all on Dr. Keshishian's site. Go through every document- you'll get all the info you need!

Imo I honestly feel you get what you pay for.  I switched surgeons when I was about 75% of the way into the pre-op process.  My initial surgeon did not charge an out of pocket fee, but they also did not offer the follow up care that the surgeon's office I finally decided on does.  My initial  surgeon's office also gave me the run around a LOT pre-op and I would wait for days or weeks for a call back, records were lost, etc.  

My final choice surgeon (Dr. Kemmeter) charged an out of pocket fee, which they discounted because I had so much already done.  If I ever have ANY issues from health to insurance and etc. they always handle it then and there or get me an answer the same day...most of the time within a half hour!  I believe (don't quote me) the full fee is normally $1500, but knowing what I know now and seeing how much they have been there for me both pre and post op, made the out of pocket fee worth it.  I had a recent hospitalization at another hospital post-op.  I notified my surgeon (after hours) and my surgeon and his colleagues kept in close contact with the physicians at the hospital I was admitted to. My PCP don't even do that!  Oh and I live almost 3 hours away too.  Follow up appointments with exercise physiologists, dieticians, etc. are not always covered by insurance.  

Yeah the fees suck, but you gotta look at the follow-up care each surgeon offers.  Imo it could make the difference between "I did ok but..." to "I rocked this thanks to..."  

Good luck in your decision, I wish you great success!   

~Roxy

 My surgeon didn't charge a program fee, but I know many do.  You're not the first to have been taken by surprise over it.

I dont blame the surgeons.  Insurance reiumbursement for the DS is very low compared to the amount of time they need to invest both in training for and in performing the procedure.  I'm thankful for the surgeons that perform the DS, and they deserve to be compensated for their time.  I wish the insurance industry could be fixed, but that's a whole different topic and for now "it is what it is"

That does seem like a lot, however once I saw what the insurance pays out I'd be willing to pay it. My insurance covers 90% to Dr. Stewart and our out of pocket will total about $750 with his program fee. So I'm guessing he gets about 3-4k for doing my surgery. Not a lot considering everything that goes into being a DS surgeon.

Yes, this is common.

There seem to be several different ways that the DS is offered, and different surgeons use different approaches.  For example (and this is very general - I don't know the exact numbers and perhaps policies have changed, so please don't think these are necessarily true "facts"):

Rabkin doesn't participate in ANY insurance plan, as far as I know.  He does not accept Medicare.  He gets his full surgeon's fee of around $13K every time.  He will submit for insurance, but he will be out of network, so the insurance companies rarely pay more than about 25-60% of his full fee (because they don't go off his full fee, they go off of "usual and customary rate" which is a totally fictitious number the insurance conpanies self-servingly make up), or less, and the patient is responsible for paying the rest.  Period.  HOWEVER, he operates at hospitals that ARE in network, so your hospital fee will be paid at the in-network price - and the hospital fees are the VAST majority of the cost of your DS, including OR, tests, meds, nursing, etc.  And of course, an extra day or two in the hospital, or heaven forfend, the ICU, and we're talking $100-250K.  So, Rabkin requires about 2/3 of his fee UPFRONT, to ensure that he at least gets some payment.  After surgery, if your insurance pays more than the other 1/3, he will refund the difference.  I personally think this is the fairests, most straightforward and ethical way of doing it - but it is daunting to bring $9K to the table all at once before surgery.  Oh, and his surgeon's fee covers the first 2 years (not including the 2 year check up) of follow up appointments.

A second model is the doctors who participate in insurance programs, like Keshishian, Jossart, Kemmeter and Elariny.  Some also take Medicare - imagine how ****ty THAT reimbursement rate is!  They accept the insurance reimbursement, but have created a separate non-insurance-reimbursable "Program Fee" - which let's face it, for most people is an additional and substantial copay under a different name - which helps make up for the ****ty reimbursement rate they get from the insurance companies (no matter what they call it, let's face it, that's what it is).  Keshishian's varies between ~$3-4K (don't hold me to these numbers - I don't actually know what they are now), I believe, depending on which surgery you have.  I have heard Elariny is a bit higher, as is Kemmeter, but I'm not sure.  And Jossart takes the cake - I heard a few years ago it was $10K!!  But, these doctors cooperate with your insurance, and probably are therefore able to do most of the insurance work.  I don't like it, but I understand it.  They are healers, but they are also businesspeople.

Oh and I heard recently that Elariny may have a whole different COMPANY he bills the DS u nder, which is NOT contracted with insurance, so he can get his retail fee for the DS even thought he is in-network for other surgeries (including non-bariatric) that he does.  Sneaky.

A third way it is covered is the usual way - if you have insurance, the doctor is in-network, and they accept the negotiated rate the insurance company is willing to pay, and you pay whatever your surgical copay is.  Straightforward.

Yet another way is the NorCal Kaiser HMO model.  They don't cover the DS, you appeal, and then they are forced to pay 100%, with Rabkin.  I like that one, but it is a painful process.

And - there is self-pay, which varies all over the place.  And I know of a REALLY good one that is being offered for a limited time - PM me.

I love the way you explained this Diana! It makes perfect sense. My surgeon from Salt Lake City, Dr. Simper, only askes for 500 and that goes for informational classes and he bills insurance for it as well. I might go back to Dr. Simper, he is a great surgeon, a lot closer, and sadly to say easier on my pocket. I don't think I am giving up quality if I stay with Dr. Simper, I have a meet and great with him in October. I guess I will see how I like the staff and surgeon. I am definatly not crossing out the other doctors due to 'program fee' now that I know this is a common thing. I understand from their view now, thanks to Diana!

I guess I will just look for one that suites me best!

HI Diana,

Yes, you are right - Dr. Rabkin doesn't participate in any insurance program. That's why I avoided going to him at first. But I didn't understand what was meant by that. And boy did I almost make a HUGE mistake! He is not signed up with a particular insurance (not a preferred provider). But his office does put the surgery through your insurance and get you preapproved (if your plan covers it). Since he's not a preferred provider, you do have to pay up front... but then your insurance reimburses you, depending on what they cover. This was an incredible discovery for me! I was FLOORED when Dr. Rabkin's office said they had a check for me to pick up from insurance totaling over 11K. Turns out my Anthem Blue Cross wound up covering nearly all of the $12K something surgery! I was left in the end paying only between $800-$900 out of pocket!!!! And the check came fairly quickly after the surgery was done (a few weeks, maybe a month tops - can't remember now). Because of the insurance thing, I almost went with Dr. Cirangle. He was technically covered by BC, but then he had the $7K surgeon's fee which was not going to be covered. If I had gone with the guy who was "covered", I would have paid over 7x more! I talked to Rabkin himself about it afterward, and he was concerned folks were getting the wrong idea about the insurance thing. But it's tricky to get the info out there. Now keep in mind, every insurance is different, so not everyone will get the same amount back as I did... but in some cases Dr. Rabkin can be a LOT cheaper!