Central Florida Questions

Hello all!  I'm hoping you can help me out here, since you all definitely have more experience than I do!

I'm currently 430, 5'7".  I've seen several doctors and no one will even talk to me past "You need to have bariatric surgery".  The one I saw today even completely shut down on me after I said "That's great... I can't afford it".  Like, walked out.

So here's my question.  I know Celebration hospital requires $600.00.  That's great... I can't do that.  My husband and I are literally living paycheck to paycheck at the moment, and struggling bad.  He works at Disney, and I just started a new job.  We just don't have the 600 dollars to throw around at the moment.

Are there any other doctors in the area that are good to work with and would work with our financial situation at all?  I know that this is something that I probably need to do.  I've done years and years of Weigh****chers, no carbs, no white flours, no sugars, counting calories, south beach, on and on and on... to no avail.  It's getting out of control and I can barely get up in the mornings.  It came to a head when I had a hard time getting out of my car due to back pain, and now I am crying out for help.

I feel like my own research is a bit of a dud, so that's why I'm posting here.  I'm hoping that some of you can point me in the right direction, or even just words of encouragement would be nice.  I'm tired of doctors walking out on me.  :(

Thanks so much for reading this far.  I feel like I'm rambling at this point, so I'm going to stop now!

Do you have insurance?

We have Disney's Cigna Med 70 insurance, which I know has a good record (from what I've heard) of approvals.  It's just the up front costs that would be hard, like stuff we would have to pay before the surgery.  Afterwards I know we can take our time more and work out payment plans.  

This is all very new to me... I've been thinking about surgery for years but this is the first time that I've truly been serious about it and it feels like a bit of a road block that we're struggling right now.

Not all surgeons charge a program fee, but you might have to go outside of the Orlando area.  Get a lost of providers from your insurance company or start calling the surgeons listed on this site and find out who does not charge a program fee.

Red

First things first:

Find out from your insurance if they will approve you to have bariatric surgery and what kinds they approve (band/gastric sleeve, etc/rny).  Find out how much they pay for bariatric surgery!  Do you have a co-insurance payment (PPO)? (i.e., do you have to pay 10/20/30 or an even higher percentage of all of your bills? Or do you have an HMO where all you pay is your copay (which is usually very small); however, you must go within that HMO's network?  Those are important things to know prior to even thinking about getting your insurance to pay.

As far as the ever so popular "administration fee,"  -- there are doctors in the Central Florida area who do not require this fee upfront (Dr. Grossbard in Zephyrhills is one I know of).  But, nine times out of ten, the doctors who don't require the "admin fee" are not in your insurances network or they don't go to a "center for excellence" hospital that specializes in bariatric surgery (which might be another requirement of your insurance company you will need to check on!!  Do they reuqire you to go to a Center For Excellence hospital?).

Because of the nature of bariatric surgery, all copays/coinsurances are required at the time of service and generally all admin fees are required prior to you seeing the surgeon.  I see Dr. Murr in Tampa, Florida. I paid a $750 admin fee.  I have an HMO and I only pay the copays for my visits ($25). I'm fortunate.  Not everyone has insurance like I do.  And yes, I was fortunate enough to have the $750 admin fee as well. I have a friend who doesn't and she's having to save her pennies for her surgery.  Have garage sales, sell items on EBay, bake sales...whatever it takes. 

Also, IF your insurance covers bariatric surgery, it's more than possible you will need to have six months of documented CONSECUTIVE attempts to lose weight. You can do this by seeing your general MD every month for the next six months and he needs to document appropriately (the best way to educate your general MD on bariatric counseling is attending an ORIENTATION with anyone of the surgeons and they can tell you what to tell your MD).  Some MD's know and some don't.  If you have the money, you can see a nutritionist who can do the same counseling for you and possible even your insurance would cover it.  There's A LOT to learn about bariatric education and I'm very thankful I had to get all the education I've gotten so far! 

While you're doing this, save your pennies for the admin fees if you can't find a surgeon who doesn't charge one and your insurance will accept!  Have your garage sales, etc. and get educated!  Make a list of what your insurance covers, the hoops you have to jump through and set dates for reaching those goals.  I swear if you do it just how I've told you to do it, the time will fly by and you will have the money made!

Sooooo it looks like you have some homework to do :) However, the effort of all of these hoops you have to jump through is so very worth it!  I just wanted to be reaslistic :) 

Take care and let me know your progress!

I am having my RNY surgery on Wednesday with Dr. Marin Radulescu at ORMC in downtown Orlando and I have not had to pay him a penny out of pocket and I've already had two office visits with him. They are great about working with you on everything. I would definately check him out. The first thing you definately need to do is go to the information sesssion (totally free) and give them all your insurance information so they can verify your benefits and tell you what you have to do to get approved for surgery. Most people, including myself had to do 6 months of physican montiored weightloss with the primary doctor, as well as nutritionist consult and psyc consult, but they can help you with all of that. That is why you need to go to the information session. You can find out more about Dr. Radulescue and his team here - http://orlandohealth.com/orlandoregionalmedicalcenter/OurMedicalSpecialties/Bariatricsteam.aspx?pid=6146

or

www.centralfloridabariatrics.com/index.htm

Good luck and let us know if you need anymore help.

I have Cigna insurance where I work.  You do have to do 6 months weight loss management with a doctor.  I used Dr. Jawad in Ocala.   I was going to use someone in St. Augustine but they were not on there list yet as a Center of Excellence. I had called Celebration and not only do they have a 600 program fee but they also require a pysch. clearance and you have to use their doctor who does not accept anyone's insurance so you have to pay the 500 up front for that as well.  I was only expecting to pay up to my out of pocket max of 1500.00.  I could not afford these fees and they would not have gone towards my out of pocket.  Dr. Jawad does not have a program fee.  I did have to pay all of my total out of pocket that had not been met yet the week before my surgery.
Good luck and let me know if you have any questions because I am sure I have probably not included everything.

Dr. Jawad has an Orlando office and I believe that he will on occasion do a seminar here.  You might also want to look into Dr. Lou Harold,  http://www.louharoldmd.com/  .   He has his support group meetings at HealthCentral and the next one is tomorrow.

Red

Dr. Jawad is having a support group meeting on Monday, 5/24.  I had my surgery done by him on April 14th and never had to pay an admin fee of any kind.  Actually, they billed my insurance company for the admin fee.  His main office is located in Ocala and the surgery is done at Ocala Regional Hospital, which is a great hospital.   Good luck to you.

Thank you so much for all of your advice everyone!

I'm going to start doing my research, and start working on getting started.  :)  I feel more hopeful now that I'm going to be able to do this!  Thank you thank you!