MGH $925 fee!!!

Any going through or having gone through MGH for surgery, has anyone ever been able to get a breakdown of the enormous fee of that has to be paid out of pocket for "uncovered expenses" by insurance. Not only do I think I cant come up with it, it bothers me that there is no breakdown as to what exactly it is for. The hospitals/physicians are paid handsomely for these surgeries and make a LOT of money. I am very concerned about this. Has anyone (I will be, believe me) asked for a breakdown on what this is for or made arrangements to pay a little every month or week?

Hi Sally, Most of the Boston Hospitals charge a $500 program administration fee. They claim it covers the support group meetings, and preop weight loss meetings if required for insurnance. Could the other $425 be your insurance deductible?? I had a $250 deductible so I did end up paying $500 plus $250 for the surgery. Joan F

I was lucky enough to join my Doctors program before he had to start a fee (500) But he did tell me that because he is a for profit office, just associated with the hospital, not run by them, that in order to keep running like they do the office had to do something. I think even if i had been asked to pay this fee I would because I love my doctor and his office THAT much...Hope this helps. Also, I cant see any reason your doctors office wouldnt work out a payment schedule. I mean they are a business, these things happen, if you want the surgery bad enough, things will find a way of working out! Have faith... Ellen

Hello, I can't speak directly about your program at MGH but I am going thru UMASS and we have a $350 fee out of pocket. This fee is for the exercise classes we are required to attend. This part is not covered by insurance. However some insurers will cover a portion of this. I have BCBS network blue HMO and they will cover $150 for an exercise program (the YMCA for example) I can show them that I spent the $ on this and get 150 back. Good luck. DC

My surgeon's office charges $550, and it bugs the Hell out of me! Frankly, I see this as a way to bypass the agreement that they have with their insurance companies to charge only 'usual and customary' fees for procedures, and write off the rest!!! Most doctors/hospitals etc. have agreements with all the insurance companies for which they are considered part of the network. They agree to a fee schedule in their contracts with these insurance companies. If they typically charge higher than the agreed-upon fee, they agree to write off the difference for those who are insured by that particular insurance company. These "program fees" are probably a violation of that agreement. It's not entirely above-board, but it seems as though these doctors/hospitals/programs have us over a barrel - if we make a fuss they simply refuse to perform surgery on us. I'm disgusted with them for doing this, and disgusted with myself for going along with it!

As a health professional whose job it is to provide services not covered by insurance, I must say that I can see very well why these administrative fees are in place. I set up classes, spent hours preparing ,ordered refreshments and several times had no one show up, even though they had registered! When I started to charge a registration fee my show rates improved dramatically. People value what they have to pay for even if it is a small amount. When you think of the volume of people inquiring about this surgery and the work hours that go into getting patients evaluated and approved, you have to allow for some way for professionals to be paid for these services which are only paid for IF the surgery takes place. I don't think we have any idea how many people start the process, request information, may even get to be scheduled and then back out. This surgery is major life decsion. I am sure having to make the investment in the administrative fee ensures that patients are truly committed to the process. Just my two cents worth! Luann

Hijack! Are you the "Kim" that used to work at Fabric Place, and attend the aerobics classes in Ashland???

I had my surgery in August with Dr. Hess at Boston Medical Center, the only thing I had to pay for besides my co-pays was my pschy visit and that was because the person did not participate with my plan. It was only $125.00. There is no program fee and the pre and post-op care has been great. I would look around and see what else is available as the doctor is contracted with the insurance company and should not be charging fees beyond what he is contracted with the insurance company to receive. I work for an insurance company so am very aware of the policies and contracts. Best of luck to you in whatever you decide. Ginny M. 8/4/04

Hi Sally - I seem to recall paying about $800-$1000 total for my husband & I to both go through the pre-operative process at Tufts/NEMC, Boston. It made me upset *then* - that it wasn't covered, but to tell you the truth, scraping that up was so worth it. Something else that irked me was that I would have to pay a hefty payment for "post operative" small group support. Therefore, I didn't go. I feel I should have, but didn't/could afford $50/$100 (for both of us) as co-payments for a support group. I see it *NOW* as a small price to pay for the life I got back - but it was very upsetting at that time - since we were on such a tight tight budget. I remember saying that we could just use money I'd normally use on groceries. :-x I think that's what we DID, too. Good luck to you in your endeavors! Keep your chin up! Beth -158 lbs, 10 lbs to GOAL! Updates here- check it out! http://meltingmama.blogspot.com/

My apologies - logged in as my husband again. Ya think I'd learn by NOW?! Beth -158 lbs, 10 lbs to GOAL! Updates here- check it out! http://meltingmama.blogspot.com/