My Brother & His WLS Journey
My brother got his date for his RNY with Dr. Walton today. His pre-op is November 4 and his surgery is scheduled for November 10. Unfortunately, he hasn't had as good of an experience with Weight Wise as I did, so he is having second thoughts and actually considering changing doctors!!
To me, I feel like he has gotten this far... why would he want to switch doctors now? It isn't Dr. Walton, but his patient advocate (and possibly other staff) that he is disappointed with.
He has insurance approval, but thinks that WW isn't keeping their word in that they said at the seminar that they will honor "in network" prices.
I think he needs to chill out and see what they tell him the final price will be. I think his advocate spoke too soon before she really checked in with insurance to see that he has already met his deductible (she told him that he would have to pay his deductible - and he doesn't want to pay it AGAIN)...
Anyway, I guess my brother needs your prayers also that everything will fall into place for him and he can get this surgery before he loses insurance coverage!
(BTW, what I mean by losing insurance coverage is that his plant where he works is closing down in December or January, so he will be jobless, therefore, insurance-less!)
Thanks everyone,
Dot
To me, I feel like he has gotten this far... why would he want to switch doctors now? It isn't Dr. Walton, but his patient advocate (and possibly other staff) that he is disappointed with.
He has insurance approval, but thinks that WW isn't keeping their word in that they said at the seminar that they will honor "in network" prices.
I think he needs to chill out and see what they tell him the final price will be. I think his advocate spoke too soon before she really checked in with insurance to see that he has already met his deductible (she told him that he would have to pay his deductible - and he doesn't want to pay it AGAIN)...
Anyway, I guess my brother needs your prayers also that everything will fall into place for him and he can get this surgery before he loses insurance coverage!
(BTW, what I mean by losing insurance coverage is that his plant where he works is closing down in December or January, so he will be jobless, therefore, insurance-less!)
Thanks everyone,
Dot
Ouches!
I would suggest this...Changing doctors is not going to change the price and IF he decides to change to a different group of surgeons he would have to start all over again and then he may not get a surgery date before insurance runs out.
Does he have plans on what he will do after surgery when he has to see the surgeon ( after the 90 day grace surgery period)? Or GOD forbid he has complications like I have?
Prayers going up for him
I would suggest this...Changing doctors is not going to change the price and IF he decides to change to a different group of surgeons he would have to start all over again and then he may not get a surgery date before insurance runs out.
Does he have plans on what he will do after surgery when he has to see the surgeon ( after the 90 day grace surgery period)? Or GOD forbid he has complications like I have?
Prayers going up for him
being healthy has its rewards....take the challenge and just do it
I think he plans to get a private insurance plan. But, it most likely won't pay for WLS. Might not pay for follow-up either... I guess he is taking a chance on that...
My insurance didn't pay for my RNY but luckily, they paid $6000 of the $8000 bill I had for my stricture. Some of it was wrote off too, so my part is under $500.
My insurance didn't pay for my RNY but luckily, they paid $6000 of the $8000 bill I had for my stricture. Some of it was wrote off too, so my part is under $500.
Dot, your brother really needs to think this through because most insurance won't sell you a private plan if you have had wls. Just something to think about. If he changes doctors now he probably won't get a surgery date until after the first of the year with everyone wanting in before their deductibles starting over. I will be praying for his situation. I wish him the best.
Emily
Dot,
I had a friend who went through this and when it came close to job ending she was denied her surgery. And had to wait another 6 months with the new company to be approved. I called a friend who is in the insurance business today..LOL kinda for you and I wanted to let them know I was going to be in th hospital again.
He said that when it comes to private insurance policies unless he is able to pay a high monthly payment very few policies will cover you after WLS. and they do not cover any expenses that related to WLS. He advices to try and keep the coverage who he has now and pay the difference from going from a company policy to that of an individual. I have a self employed insurance policy and I pay more to have WLS coverage. Thank God I took the policy when I did cause now I would be paying 2 times what I do.
I had a friend who went through this and when it came close to job ending she was denied her surgery. And had to wait another 6 months with the new company to be approved. I called a friend who is in the insurance business today..LOL kinda for you and I wanted to let them know I was going to be in th hospital again.
He said that when it comes to private insurance policies unless he is able to pay a high monthly payment very few policies will cover you after WLS. and they do not cover any expenses that related to WLS. He advices to try and keep the coverage who he has now and pay the difference from going from a company policy to that of an individual. I have a self employed insurance policy and I pay more to have WLS coverage. Thank God I took the policy when I did cause now I would be paying 2 times what I do.
being healthy has its rewards....take the challenge and just do it
I know that they now have a new patient advocate. If he is having issues with her I don't think he would be out of line in asking to use the new one. I know that an insurance company is not going to make you pay a deductible twice so she did probably speak before she researched. Good luck!
This is the ride of my life.....what an amazing tool I now have!!!
Thanks everyone for your replies... He has already been approved by insurance for the surgery and the date is set for November 10. I don't know why he would even think of changing surgeons at this point in the game...
I am on his list of people who they can talk to about his case. You know, the HIPPA thing... So, I called the patient advocate today and talked to her myself!! Here is the low down...
She said that there are two deductibles. An In Network deductible (his is $400 and met) and there is an out of network deductible (his is $1000 and not met). She said that they do consider themselves in network even though they are not BUT the out of network deductible applies (which I think is TOTALLY STUPID)... Either you are IN NETWORK or OUT OF NETWORK... not picking and choosing when you are going to consider yourself in network and when you will consider yourself out of network!
So, in this case, she is saying that they will charge him the $1000 right off the top and then as per the in network policy, he will then be responsible for 20% thereafter. That is where she is getting her numbers.
He said something he heard at the seminar (and I remember now that he reminded me) that they say something about sending the patient 3 bills and if you don't pay them they will write it off. It has to do with insurance fraud. It is illegal for them not to attempt to get payment, but if you refuse to pay, then that is OK and they have the right to write it off if they choose not to persue it with collections.
So, he is going to talk directly to Dr. Walton on Tuesday and see what he can find out about this. I agree that it doesn't sound like they are standing by their word that they gave at the seminar. I plan to go with him on Tuesday, so I'll keep you all posted with what we decide :o)
Thanks again everyone!
Dot
I am on his list of people who they can talk to about his case. You know, the HIPPA thing... So, I called the patient advocate today and talked to her myself!! Here is the low down...
She said that there are two deductibles. An In Network deductible (his is $400 and met) and there is an out of network deductible (his is $1000 and not met). She said that they do consider themselves in network even though they are not BUT the out of network deductible applies (which I think is TOTALLY STUPID)... Either you are IN NETWORK or OUT OF NETWORK... not picking and choosing when you are going to consider yourself in network and when you will consider yourself out of network!
So, in this case, she is saying that they will charge him the $1000 right off the top and then as per the in network policy, he will then be responsible for 20% thereafter. That is where she is getting her numbers.
He said something he heard at the seminar (and I remember now that he reminded me) that they say something about sending the patient 3 bills and if you don't pay them they will write it off. It has to do with insurance fraud. It is illegal for them not to attempt to get payment, but if you refuse to pay, then that is OK and they have the right to write it off if they choose not to persue it with collections.
So, he is going to talk directly to Dr. Walton on Tuesday and see what he can find out about this. I agree that it doesn't sound like they are standing by their word that they gave at the seminar. I plan to go with him on Tuesday, so I'll keep you all posted with what we decide :o)
Thanks again everyone!
Dot
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