What would you do?

I have a co-worker friend who is going through a bariatric program at another provider thatn the one I went to.
She is financially strapped for money. Her program requires  $600. cash paid before she can advance through the next steps to progress to surgery. I phoned this program and was told this is for the things not covered by insurance. BULL- I administer our health insurance and know what will be covered and not covered. The hospital this program uses is no longer considered "preferred" in our network- she'll have some additional costs now of $100 day co-pay and $200 deductible for testing there. So she's looking at $1100 out of pocket, at least.

I had the same surgery at EMMC, with the same insurance, went through the steps  and incurred $245 out of pocket, $200 deductible for sleep study assesment, 2 x $15 copay for sleep study MD visits and $15 copay at my surgeon's office. EMMC remains a "preferred" hospital on our health insurance.

Now for the question-----Do you think it would sticking my nose where it doesn't belong to suggest she check out the EMMC program??? She's done several of the steps leading to surgery, dietician, psych eval. It would mean traveling about 1 hour to Bangor for appointments.

oh my   Maine gal  I dont know how to answer that one.   If she is more of a friend then a co worker  i would   tell her i guess.   Just really not sure.
have a great day

I would tell her! anything to save some money....

That's a tough one, she has come so far.  But, it may be worth mentioning to her.  Just as an FYI? It also may be a good idea to call the program back and let them know what you know.  That might make them change their minds about asking for the additional money.  I'm just not sure, I checked out the program in Augusta and left there feeling like I needed a shower.  Just seems a little shady there.

The $600 isn't for "nothing."  Honest :) It is for things not covered by insurance.  The office in question (If I am guessing correctly) provides for 3 visits with a personal trainer at the office. As well as both pre/post-op combo support group meetings and post-op only meetings.  They are staffed by the office staff and the nutritionist, instead of patients/volunteers.  None of those events would be covered by insurance.  Some offices cover them as part of the entire billed insurance cost, and many others charge a "program" fee similar to this office.  In many ways we are lucky to have EMMC that does not have a fee and lucky that Augusta is only $600...someone last year said their office (out of state) has a $2000 fee...because of the low amounts insurance companies pay they are forced to bill someone.  And as far as the hospital being out of network...I think all the insurance companies have moved them "out of netweork" the hospital itself is so outrageous in their billing fees that insurance companies can pay 50% less to any other hospital in the state for the same service.  It is nuts!  They have a great staff, but an awfully high price!

It's not ideal. i know that.  I just had to defend the the office, not the fees really, although  It is pretty common now. 

So there goes my "sticking my nose in where it doesn't belong"   SORRY!!!  If it makes you feel better, the office she is going to is wonderful!  :)

:) Sheli

It was never a question concerning the provider. There are many, many good doctors out there. It was a financial question. I don't want to get into a doctor "war"

With my insurance hospitals are either "preferred", 'non-preferred" based on meeting clinical national standards. Shell- the hospital you mention didn't meet National standards for pneumonia and cardiac care this past year. Nothing to do with the billing.

I say YES tell her.  If it means saving her some of the money, even if she has to travel a little further, and pay the gas prices it still would be a savings!  I too started my program in the Augusta area, which is who I am assuming you are talking about because of the non-preferred hospital statement you made and I was NOT willing to give them $600.  Why, because EMMC would do the same things as this hospital and not charge the out of pocket, not to mention that EMMC is a center of excellence as you know.  Maybe just maybe and I am not sure, but they might accept the pysch eval. from the other pyschiatrist but not sure, all something she could ask about and look into and decide from there.  Even if she is only a co-worker, I would still tell her.  That's just my opinion.  Also its so good to hear your doing so well...Keep up the good work...Angela

I say yes and let her know about your experience and then she can make the financial descion for herself. From what I've read here all the surgeons in Maine are wonderful and caring. I'm sure she will get great care no matter where she goes. She may not want to change doctors if she's already paid some money up front. I went to Dr. Loggins in Lewiston and only had to pay for office visits (co-pay $15) and I had an insurance deduct. of $200. My out of pocket was minimal. I'm sure she'll appreciate you caring for her but don't push her. Just give her the suggestion/option of saving some money. Good luck.

OK- I e-mailed her and suggested looking into other programs. She's been thinking about this already and wondering what would transfer into a new program. She'll have to contact programs and tell them how much she's done and what they may require in addition.

Thank you for your responses. Sometimes I need to bounce these thoughts by you folks to check and see if I'm on the right track or totally playing "big sister, boom, boom". 

Another something you don't know about me- I'm the eldest of 4 children and was a terribly bossy big sister when we were growing up. Trying not to be that anymore.  

Emily, I didn;t realize why they lost their "preferred" status.  Crummy!  I wonder if that is part of why the hospital fees are so high...maybe more people are chosing to go to hospitals that are in-network, and therefore they are having to charge more to cover their overhead,  Interesting.

I think you did the right thing though, because it is not about the doctor's office, it is a cost issue.  I was STUNNED how much my insurance was billed for my surgery.  My lap-band with the hospital bills included, billed out at over $30k...insurance didn't even cover $10k, but at the time it was in-netowrk, so they had to accept the insurance amount as full payment.  Seriously, $30k for day surgery, no overnight stay.  Even without the $600 office fee, that is still a lot if she had a high co-pay percentage or a high out of pocket limit.  (My bff has a 20% co-pay and has to pay 100% of the first thousand, then her 20% part can be up to another $5000 before she owes nothing.)  UGH!  Add $600 to that and it would be cheaper to fly to Mexico...I never thought of that before but WOW!  :)