GHP - Their Scam

Hey GHP patients,

Dr. Foote did my Sleeve, and I couldn't be happier with him and the MEDICAL care that I have received there.  I am down 140 lbs, and no major problems.  My sister has seen all of the awesome benefits of WLS, and wants to start her journey. 
She is also looking to go through GHP, and she is in a tougher spot financially than I was, and she needs to spend as little as possible.  We all know that WLS is not cheap, but I was trying to offer her solutions, and was appalled to hear what she found out.  I suggested that she see an outside behavioralist/dietician for the pre-op evaluation, not only because of the cost, but because Scott just rubs me the wrong way.  She asked if she could do this, and she was told "No, you must see Scott, its part of the GHP program".  Okay, this I can sort of understand, because they know what they're looking for, etc. although I think that there has to be some other licensed mental health professional outside of the GHP office that could do this, too.  Ok, so you have to go through Scott - but why do they REFUSE to bill your insurance?  When I went through the surgical process, I just assumed that they knew that my particular ins. wouldn't cover the visit, so they weren't wasting my time.  No.  They simply don't bill any insurances for the Behavioral visit.  That is simply their policy.  I think this is ridiculous!  My insurance covers behavioral visits, as does my sister's (and probably many of yours out there, too!)  I understand that it would probably be a hassle for GHP, and that it would most likely extend the waiting period, but for people like my sister, who have more time than money, it would be nice if they offered and let you opt out if you're in a rush. 
And I can't help but wonder why they refuse this, is it possibly because Scott isn't licensed in all of the ways that insurance requires?  I'm sorry, but he was extremely unprofessional when I saw him, and I wouldn't be surprised at this one bit.  And isn't $200 a bit steep for one appointment?  I pay under $25 per visit to my current behavioralist, and even without insurance it would only be like $115. 
 Then again, if they are saying you HAVE to have it, and they REFUSE to bill insurances (maybe also because insurances help regulate costs and wouldn't let them charge so much), otherwise you CANT have surgery, we will gladly pay this, right?  I think its a scam, and I urge all new GHP patients to stand up against this policy.    I wish I knew about it sooner, and I regret having believed them and paying full price!
Has anyone out there gotten around this?  If so, my sister would really like to know how!!

Just a thought
Can you submit the paid statement for reimbursement to your insurance company?

Love love love the new avatar Mary.  You look marv.  Fun isn't it?

Ilove the new pic...you looooook sssssoooooo happy and butimous!

 Kristie,

I don't normally play Devil's advocate, but I can think of a few possible reasons why they require perpective patients to use their Behaviorist.  One reason may be that they have specific criteria they are looking for in finding patients that will make good surgical candidates. Having an "inhouse" person would be benificial in already knowing the critieria and having open discussion with the surgeons over decision making. Different counselors may not know the basic qualities they require- As you know, dedication and realising that surgery is just a tool and not an answer and making sure a patient is accepting of these factors play a larger portion in decision making.There are some counselors out therewho don't know alot about weight loss surgery and the requirements.
When it comes to the billing or not billing insurance for the appointment with the Behaviorist it must just be their policy- You should be able to submit your own form from the bill and and codes listed on your paperwork,  As far as the prices differentiation- I know nothing. Hope I may  have helped a little with the other information, I don't believe it is being set up as a scam- Keeping things "in-house" shortens the timeline for surgery and most patients are  happy to go through the initial steps as quickly as possible. Hope this has helped

Amy H
rny2001
359/134

I agree with wigglypoo.  There are certain things that Scott would know to ask that an outside Behaviorist might not think to.  I thought Scott was pretty nice, I did a lot of talking though and I did grow up with some issues with verbal abuse and such so I enjoyed unloading. 

I did look back at my paperwork and noticed that part of the $1,000 I paid up front does include the behaviorial visit so I will be checking to see if I can submit for reimbursement to my insurance. I thank you for reminding me to . look over the paperwork again.

I just had my sleeve on the 15th of December.  I'm a newbie. :)

Yeah, I posted this on the VSG website, and they all reminded me about submitting to the insurance afterward.   Maybe your experiences were different, but for me, they always said "insurance doesn't cover those visits", so they never made it seem like billing would even make sense.  We took it as "Your insurance will not cover Scott at all---> You have to use Scott because we say so ---> Even though you might have great insurance, we refuse to bill it and the only answer is because your insurance just wont cover it even though we don't know for sure"
I've gone from mad to frustrated that they don't even suggest billing afterwards. 
Has anyone out there billed afterwards?  I am curious about Scott, because I know many insurances will cover individuals or "clinics" as a whole, and he is not in a clinic, so I wonder how many insurances cover him, because they make it seem like he doesn't work with anyone, and for something "extra" like a behavioralist visit, insurances are picky. 
I know, I'm just grumbly about it, but I was really mad at them for how badly they discouraged my sister, and how unhelpful they were for her. 
Thanks for the suggestions.

I can understand your point; however, we are told up front, at the orientation, that there is a $1,000 program fee.  We make the choice to take it or leave it.  There are lots of other WL surgeons in Michigan, even in GR.  We are free to choose whom we want to see.  It is common, from what I understand, for WL practices to charge program fees, and from what I've heard, $1,000 is actually on the more reasonable side.  We always have the option of trying to get out insurance to pay for some of these visits to help offset the program fee.

Part of the insurance issue is credentialling.  For each of the insurances they bill for surgery the behaviorist would then need to be credentialled.  It is a lengthy process and very costly to GHP.  Not only that but criteria for credentialling changes yearly based on insurance requirements. Having worked in the medical field for 17 years I can see why they don't do this.  Going through the credentialling process doesn't not guarantee participation.  Second, my insurance required both inside and outside evaluations.  Scott isn't the ONLY behaviorist at GHP there are two others.  I had Scott for my eval and found that he asked a lot of questions that were "touchy" to see how I would respond honestly.  Anyone can sugar coat a Dr. in an eval to get the desired response they are looking for.  Scott's role is to make sure there are no underlying issues that will prevent success for the patient.  I guess we can moan and groan about GHP and what their standards and criteria are or go to MMPC instead but no one is forcing you to go, it is a choice.  With each choice one needs to be educated about what the expectations are.  I wish your sister good luck in finding anything better in the GR area.  And no there is no way to get around this.

I had my pre-op appts over a year before I had surgery, and it was back with MMPC.  At that time, Scott was the only behaviorist in the office.  I will make sure to tell my sister that she has a choice, and to make sure not to see him. 
Its not at all that I was uncomfortable with the questions, its obvious that they need to get an honest answer from you before they change your organs around.  It was the fact that he was a religious fanatic, with religious paraphenalia all over his office.  He's allowed to have whatever beliefs he wants, but it shouldn't be brought into his workplace like that, and I know that I am not the only patient who felt like he was using religious beliefs as part of the criteria.  He also documtented things into my chart that were completely irrelevant and discriminatory.    The person I now see didn't even have to ask his name when I said that I didn't want to see the person at my dr's office - he apparently has a reputation in that community as well. 
I know that it is a choice, but that is the kind of attitude that stops patients for asking for something better.  If we are constantly told "oh well, that's the way it is - you are choosing to be here", rather than "I understand your concerns and will try to help you".  I am just saying that maybe if patients fully understood what that program fee entails (I am the first to admit I didn't fully understand what everything meant - I was 19 when I went through all of the appointments), and that there should be other options, then maybe GHP would be a little more patient-friendly in their office practices.