MGB and problems

Anyone have MGB and have problems? Any info would be great Melissa

Hi, Melissa! I had an MGB about 5 months ago and have not had any problems at all. I can eat anything I want, just way less than I used to. I'm just curious...who is Dr. Bauman? I only know about three or four surgeons affiliated with Dr. Rutledge, and I've never heard of him. Maybe I missed something? Anyways, best wishes and good luck! Julie

He is a different doctor who does RNY. If I decide to go MGB it would be Dr. Dasher. Melissa

Melissa, I briefly checked into the MGB before deciding to go with the RNY. Just wanted to ask if you were aware that Dr. Dasher's office doesn't file insurance for you for the MGB. Or at least they didn't when I checked into it which was about 6 months ago. They said you had to pay up front (approx. $17,000) and then YOU could file with your insurance company for reimbursement. That was ONE of the main reasons I decided against MGB. Just thought I'd pass on that information. . . Take care and good luck with whatever surgery you decide upon. Donna

While I don't doubt in the least that this doctor does this practice of having you pay up front and then filing your own insurance, that is insurance fraud on the part of the doc. Docs do this so they don't have to write off their contractually agreed upon amount. If the insurance company and the doc write a contract and agree to $12K for a $17K procedure, HE AGREED TO THAT! He can't turn around and charge the patient the other $5K. It's fraud. That is the whole idea behind the contract. Someone should tell the insurance co's what he is doing. While there is nothing wrong with a patient paying up front and having the insurance co reimburse the patient, there IS a problem with a doc charging a patient for what he (in writing) agreed to write off. Makes one wonder what he owes Medicare in fraud. I used to work for a neurologist that did this sort of thing. That's why I quit, I wanted nothing to do with his fraudulent practices. He did end up getting caught, had to pay a lot of money in fines and reimbursement, and almost lost his license over it. This is a big deal and quite serious.

His policies regarding insurance filing may not be the same as they were when I was considering the MGB. I just know that at that time the office wanted the entire amount up front BEFORE the surgery and that is one reason I chose not to use them. And like I said, the $ amount was an approximate amount - there was absolutely nothing stated in writing and in fact the cost may have been quite a bit less. I'm sure they know what is fraudulent and what is not and I did not mean in any way for my post to sound like they were doing anything considered fraudulent I just wanted the original poster to be aware that some offices (for WHATEVER reasons) don't file insurance before asking for payment and that she should be sure to check into this when researching surgeons. Sorry if my post was misleading in any way! Thanks! Donna

Donna.... Your post was not misleading in any way. *I* am the one that brought up the issue of fraud. You just stated the facts as you know 'em.

Please check with your insurance regarding coverage. My company would pay for RNY or lapband, but considered the MGB to be experimental. jeannine

I don't know of ANY insurance companies which cover the MGB surgery.  It is considered "experimental" even though it is a slightly modified version of an older surgery which is no longer performed.  Sometimes (rarely, insurance companies will cover experimental procedures), but it takes a lot of work, proof and unique cir****tances.   My guess (and it is just a guess) is that your surgeon can't get any insurance companies to cover the surgery so he has his patients pay up front then try to deal with reimbursement on their own.  Trying to get reimbursement after a surgery is a long shot and if the surgery is considered "experimental" there is all but no chance of reimbursement.  This surgeon is either violating his contract with the insurance companies, or realizes that the procedure is rarely if ever covered so he doesn't bother with pre-cert. After my research (and I did a great deal since I wanted MGB surgery so much that I almost self-paid), I decided to stick with the "gold standard" RNY.  Keep researching and if you still think MGB is best for you then perhaps it is worth self-payinf for it. 

None of the MGB docs do any insurance files... all are self-pay at $17000.  It's been that way since about 5-6 years ago, when Dr. Rutledge had issues with the insurance companies over his procedure. (I think it was a coding issue... back when he was in NC).  Anyways, to avoid any further issues, he decided to go to a strictly self-pay model.  It is not fraud, by the way, for him to do that and for an insurance patient to submit a claim on their own for reimbursement.  It's unlikely the insurance company will reimburse, but it is not fraud.  It would be fraud, however, if the payment went to the surgeon. I've been on WLS boards since 1998. (Even OH since then... only under a different profile.)  Havent' seen many complications with MGBers, but a few have chosen revisions.  Seems to have a lot of success, low complication rate, etc.  I'd join the MGB Yahoo Group and ask for some names of some long-time MGBers.  Should be able to find people who are 6-8 years out. Good luck :)