New Here, Already Complaining :(

I decided back last year I was going to have the Lapband procedure done. I live in Moore and of course my first choice for a surgeon was Dr. Keith. I attended his seminar in Nov. 2007 and immediatly LOVED him. He is so down to earth...however, a member of his staff came in after Dr. Keith was done and started speaking about insurance. I was very disappointed...my insurance carrier (Aetna) is very good. I have a pretty highend plan that my husband pays a lot of money for. They require a 3month dietician supervised meal plan prior to approval. I found out from this rep from Dr. Keith's office that dietician visits and psy evals are NOT turned in to my insurance, resulting in high out of pocket expenses for the patient. I don't even get to put them towards my deductable...so they are basically like uncovered visits!!  Why wouldn't they file with my insurance??? It makes NO sense (except from a revenue standpoint for them). Aetna covers everything from dieticians to psy evals. All I'm required to pay is a small co-pay. I've picked another doctor that I'm very happy with but he's not so close to home, I was really hoping to use a Norman doctor, especially Dr. Keith...he's so amazing, I can't believe his offices do this.  I refuse to pay out of pocket for services that are covered, that's why I have health insurance for God's sake!!!! Has anyone been able to work around this?? Or can you explain WHY he does this?? I mean seriously, I can afford it, but why would I pay for something that's COVERED??? I'm so confused and really upset about the situation as a whole. It's disappointing to look forward to having a certain doctor only to find out something like this.

I'm using Dr. Nelson, Dr. Keith's partner (althought both of them will be present in my surgery). I'm not having this issue. Have you spoken with Barry, the office manager? While the psychologists are not on our Preferred Provider's list, a portion of their visit is covered by our insurance, Federal Employee Program BC/BS. I will be partially reimbursed for their services. But, I do pay them for the visit first. These psychologists specialize in weight loss issues, so they're not just the routine private practice psychologist. The dietician is not covered by our insurance plan. Either OWLO, or I, will submit the psychologist charges to my insurance company and I will be partially reimbursed. This doesn't bother me at all. Other surgeons didn't sign insurance company contracts (which means agreeing to their schedule of reimbursements only) and weren't on our list of preferred providers at all...so we would have had much higher out of pocket expenses. This seems to be standard procedure with the psych and dietician charges. If this surgery hadn't been covered by our insurance company (most insurance companies don't cover VSG), we were willing to finance the entire surgery ourselves. (Because of autoimmune disease, I was not a candidate for RNY or LapBand). I also know that the meal replacements/supplements will be out of pocket expenses. I'm prepared for that, too. I'm so thankful to have this surgical tool help that paying for some or all of it myself has not been an issue. My suggestion is to call and speak with Barry, the office manager at OWLO, and check on those issues of the dietician and psych. fees. I'm also glad to be using surgeons that are close to home and to be at Norman Regional Hospital ... a bariatric center of excellence and they just opened a brand new dedicated bariatric unit this year. Follow-up will be close to home, too. I would be willing to travel for this surgery, but am thrilled that I can have everything right here at home.

If for some reason they don't turn in your visits with the psych and dietician to your insurance, you can turn in your receipts yourself. That should make it apply to your deductible and probably get you reimbursement for the charges if it is indeed fully covered. Otherwise, you would get partial reimbursement.

Hi as a patient of Dr. Keith I can explain why the dietician and psych is not covered by insurance...The dieticians are not registered with insurance companies and if they were it would still mean you would have to pay some portion of the fee. THe money you spend covers all the visits you have with the dieticians and it covers the ten day pre diet class plus as any post ops can tell you these folks answer your calls and are there for you whenever you need them. As for the psych you pay up front and it covers not just the evaluation but 2 sessions with them before or after surgery. THe whole cost is $400.00 not much of an investemnt for a new you. And like you at first I was frustrated with having to pay out of pocket...but then I thought about how many times have I blown $400.00 bucks just because of my size on having to buy 2 plane tickets or one business out fit. Yep it may seem out rageous but as for me I would gladly pay that amount again...I am almost 5 months post op and I have lost 167 pounds. Some insurance companies do not pay for psych visits anyway... but file anyway you never know when they will. B****nea is one of the insurance companies that take forever to approve WLS....one of my friends waited a year before she finally got approved... IF you have any questions complaints or just want to vent email me and I will give you my number...I will be at the next support group meeting  which is april 8(tuesday) at the health plex...Good luck!!!!

Thank you for all the information!  I'm currently under dietician supervised care to fullfil my 90 insurance required diet. I'm using the dietician out of St. Anthony's which is where I'll be going if I can't get this worked out with Dr. Keith's office. She simply turns in my visits to Aetna and I pay a $20 co-pay. Why wouldn't the dietician at Dr. Keith's office be credentialed with insurance? I've also checked with Aetna and they will pay for my psy eval through St. Anthony's hospital (less a $40.00 co-pay). As far as the protien powders, I know that they will come out of pocket, but why buy them at such a high rate from Dr. Keith if I can get Unjury or Iso online for pennies on the dollar?? (the gentleman at the meeting made it sound like we HAD to buy from them, do we?? I think I'm reading WAY to much into this or misunderstanding). I am going to call and speak with Barry, I would MUCH rather have the surgery close to home and I really would like Dr. Keith to take care of me (tho the surgeon I've visited with out of St. Anthony's is wonderful). I work on this side of town as well, it's just so much easier to be in Norman. :)  I will let you guys know how it turns out, and I'm going to make an effort to attend a support meeting, I think that will help me a lot. You guys are very sweet...thank you so much :)  Any further advice/comments are more then welcome!!!

It isn't that the dieticians aren't credentialed, they are. It's just that they haven't signed insurance company reimbursement contracts. These dieticians are in private practice and do not work for a hospital, that's the difference. They specialize in bariatric patients, only. You'll find the same thing with physical therapists ... some work for hospitals and some are in private practice. They may or may not agree to insurance company reimbursement contracts. I don't feel at all that Dr. Keith or Dr.Nelson are money focused. They are among the only surgeons in the state that provide services for medicaid and medicare patients. They accept very low fees to provide services for those patients and those surgeons interested in money primarily don't provide services for those patients. The supplements are required to be purchased through Dr. Keith and Dr. Nelson's office for the pre-op diet and the immediate post-op period. Beyond that period, you are free to purchase your supplements where you choose. The physicians and  dieticians know exactly what your are consuming in these very important phases, so I can understand them limiting it to the products they approve and that you select from. I've seen on the VSG forum that many choose to forgo the quality supplements or use bad replacements for them that are low in protein and high in carbs. Those are not good choices. And, you'll notice that Dr. Keith and Dr. Nelson's supplement prices are lower than the prices of the same supplements from online websites. I've been checking and couldn't find them any cheaper (thus far) and usually the online sites charge more! If any extra fees are the most important issue for you, then double check the program you are in to make sure you won't be billed additionally later on for costs you are unaware of now, and stay with them. But, if care near home at a bariatric center of excellence with surgeons with thousands of surgeries (between the 2 of them) as experience and honest up front explanation of expected fees are important, then go with Dr. Keith. Just do what is best for you!

I'd also add to make sure you surgeon accepts what your insurance pays as payment in full along with any co-pay amount you may have. If they haven't signed an agreement contract with your insurance company, they can accept what your insurance pays and then bill you for the remainder of the fee, which can be substantial. Although they *accept your insurance*, make sure they accept that as full payment with your co - pay.  We have some friends that the husband recently had RNY surgery. They thought their insurance would pay everything since their surgeon accepted their insurance. Although he did accept the insurance, he hadn't signed a contract with the insurance to accept their reimbursement as his fee. This couple ended up paying several thousand dollars out of pocket for various expenses. So, you might want to double check that, too.

Wow there's so much to look out for. Thank you for the advice! You guys are amazing, so much info on this site. It's very, very helpful...it's also awesome to talk to fellow Okies in the same boat. :)

I don't mean to sound "mean", but my insurance pay's nothing to do with WLS.  Nothing  NOTTA, ZILCH.  So while I can understand the frustration of having to pay for a few out fo pocket expenses.  Try to remember, it's better than what some have to go through.

Luckygirl-you made me giggle.  I myself am paying $1000 to be taken in to Dr. Keiths' program-but it beats flying to Mexico or going to Houston for fills.  I am very pleased with the service I have had from them so far (I see Dr. Nelson) and I can tell you first hand if you have a problem they will call you back, even if you are not a patient.

I try not to reccomend surgeries or surgeons-but I myself am paying "extra" to see Dr. Nelson.