Surgeon in Albany Area??

Well, here is my story. My surgeon is Dr Lirio and I love the man but my insurance company approved me for a proximal RNY and he decided for medical reasons once he opened me up to perform a distal RNY. This was on 9/27/04. He never said anything about it. I got all my explainations of benefits and all parties were paid for their services. In March 2005, I get a bill from the anesthesiologist because my insurance company requested the money back they paid because they consider a distal RNY experimental/investigational. I call dr Lirio and find out they are requesting the money back from all parties they paid. To make a long story shortish...Dr Lirio appealed and still my insurance company is not paying. I called my sister who is a benefits attorney and fill her in on everything. I find out he is liable and I do not have to pay anything because he knowingly performed a procedure I was not approved for. Now I may end up taking Dr Lirio to court if my sister cannot settle this with him. If I take him to court I need a new doctor. If you use Dr Rosetti or another Doctor out of albany med could you e mail the phone number so i can see if i can see them for future check ups. Thanks Michelle

wouldnt it be the the others would be taking dr lirio to court not you. you are a victim as well, even if he did do you a great service by performing a better operation, the more distal the greater the mal absorption and longer effect the rny will have, more like the ds. they and the hospital have a monetary loss. i would surmise that you only have to defend any claim made against you for payment. check out the ds forum page for help , the ds people apeal and have a lawyer gary somebody there that can assist you.

Hey Michelle I have a question for you about this, my question is this. I thought the only difference between the two surgerys were the amount you are By-Passed, I am a DISTAL and have done great with mine, I know I malabsorb less then the next person but I never heard anything about it being EXPERIMENTAL. I started out at 420lbs so my Dr thought that I would do better this way since I had so much to lose and he was right. Sounds like the insurance company is just looking for a way out of paying there share of the bill. Also on the part where you are looking for a new Dr, well I had my surgery in LA California, I tried to get BC/BS of NE NY to pay for a Dr visit to my Dr in LA and they told me "NO" because there are Dr in our plan here in NY, well I went and called the few that they told me they would cover for my visit, problem is the Dr here said Sorry we will not take you on because we didnt do your surgery in the first place. Another thing the insurance companys do to not pay, they told me the only way they would pay for my visit to the Dr in LA was to get a letter from the Dr here in NY that say they will not treat me then maybe they would cover my office visit in LA, all that to save a 100 dollar office visit was not worth it I paid the visit myself. BC/BS is not the easiest to work with so good luck with finding a Dr that will take you and if you do drop me and e-mail so maybe I can also try that one. Tony

Tony, Its only experimental in the eyes of my BCBS which is highmark out of Pittsburgh. My surgeon even send documentation that distal is an approved procedure but they didn't care. I will let you know if i find a doc but Doctor Lirio is an excellent surgeon in Schenectady he just screwed me on the insurance thing

I have heard nothing but great things about Dr Lirio and how good he is and I am sure he is, its just to bad that the insurance company is being STUPID and looking for a way not to pay but thats what they do BEST. BUT it was him that made the choice to make you a DISTAL so it should be him and not you that has to pay, hope it all works out for you and if you do find a DR that will take you let me know. Thanks Tony

Michelle, that really stinks about what Dr. Lirio did to you. Im sorry about that. Alot of health insurances wont pay for Ds or others that they consider experimental. I know that the doctors at Albany Med wont do distal at all. I can pass along Dr. Singhs phone number to you. Good luck!! T. Paul Singh, M.D. Phone Number : 518-262-5614 Laurie

Hi Michelle, Sorry to hear about your mix up....I also have/had Dr. Lirio as my Doc. and absolutley LOVE him....I think he is a wonderful man and doc. My question is, did he tell you before hand that he may do a different procedure than planned?? That if things didn't go the way they were supposed to that he may have to do something else? Just wondering.... Good Luck with everything...I have heard about other doc's in the Albany area but my GP only recommended Dr. Lirio. Karry 311/183/167 goal

He never said a word before or after the fact that he did not do what I was pre approved for. I read through the correspondance between him and my insurance company and he wrote that he was unaware of any restriction of how much could be bypassed. Don't get me wrong I love love love Dr Lirio and his P John but I am not paying $35,000 in medical bills because of something he did. (He should have been aware of what procedure he could perform and when he didn't think it was medically the best choice he should not have done it. I would have been devestated but legally its his fault.) The whole thing sucks and if i had $35000 laying around i would pay it but since i don't...I have no choice but to take legal action if he will not take responsibility on his own