Dr. K. - program fee - out of pocket?

2011Mommy
on 11/20/11 1:09 am
Yes, I will be applying for short-term disability and that will be in conjunction with FMLA. FMLA basically protects my job and the short-term disability will provide the $$. Short-term disability pays 55% of the salary and I am VERY lucky to work for a company that supplements the additional 45% as a gift. So I will have my full salary- woohoo! I am so blessed to have this- this is the only way I am able to go ahead with the surgery and take that time off...
trxxyy
on 11/19/11 2:55 pm - Orange County, CA
I was a virgin DS by Dr. K and I had my surgery open. I have heard from other DS'ers and it seems to me that recovery speed is more determined on the individual person and not open vs. lap.  If I were to compare my recovery to the other recovery stories I have read I would have to say mine was pretty text book.  The worst part for me were the drains, once those were out I felt human again.  

I am a SAHM so I wasn't under the gun to get back to work but I think I might have been able to do so at 4 weeks if I absolutely had to and I was working a desk job. Just remember that everyone is different and recovery times are not absolute. 

Good luck and keep us posted.
2011Mommy
on 11/20/11 12:50 am
Thank you. With the lapband I was back at work 5 days later (yep, 5 days!). I don't except recovery to be as easy this time (6 years and a baby later- my body is not exactly what it used to be).
I just remember that with the lapband each day was 100 times better than the day before... the first day I literally wanted to die. 3-4 days later I was no longer taking pain meds. I wish I was a SAHM- I waited (impatiently!) for my little angel for many years and I love every single moment of being a mom. I have a desk job so I hope at 4 to 5 weeks I'll be ready to go back...
Ms. Cal Culator
on 11/19/11 10:15 am - Tuvalu
On November 19, 2011 at 6:02 PM Pacific Time, 2011Mommy wrote:
Hello,

I spoke to Dr. K's office yesterday. They checked the benefits with my Anthem Blue Cross insurance and let me know that surgery is covered and Dr. K is a contracted provider. When I asked about any out of pocket fees, I was told that there is a $4,000 "program fee" that the insurance does not cover plus all the copays. I am so disappointed- I cannot afford such a high cost.

Please let me know if this is standard for most surgeons

I am considering the other doctor listed on DSfacts.com - Dr. Peter Crookes (seems to have very positive reviews). I am wondering if he would have a similar charge. If anyone has any info- please let me know.

Thanks so much!
Lulu


In CA, Rabkin has you pay up front...and when your insurance company pays you get back whatever they pay.  Keshishian has you pay a program fee.  Crokes had a small program fee and doesn't anymore...but I've not heard rave reviews on him lately.  In fact, I haven't seen many recent Crookes DS patients.  Also, there is a "lost in phone hell" factor at USC University Hospital...but maybe that won't bother you as much as it did me.
2011Mommy
on 11/19/11 10:22 am
Thank you- this is something to consider. I have limited time to play the "catch" phone game between working full time and taking care of my baby.
Yikes- paying up front would be so hard! We are living paycheck to paycheck with my hubby being out of work BUT the option I am contemplating is putting more money in my flexible spending account. I usually put 2K per year but I could increase it to 4K (but my take home $$ would decrease :( ). I will also be getting a check from Aflac - it's $400 for each day in the hospital so I was planning to use that to pay all the copays etc. 
Money is very tight but I am determined.
(deactivated member)
on 11/19/11 3:19 pm - San Jose, CA
Just to clarify a minor point - Rabkin requires 2/3 of his surgeon's fee upfront, and if the insurance company pays more than the other 1/3, he refunds the difference.  If the insurance company pays LESS than the 1/3, you owe the difference.

But at least one of the hospitals he uses is usually in network for insurance purposes.

Back in the day, that meant I had to come up with $8K upfront.  My insurance paid $7500, so I got back the extra $3500.  My hospital stay was a $100 copay, plus $600 ($200 per night for 3 nights) for a private room, so my husband could stay with me and help take care of me - and so he didn't have to pay for a hotel room.  I considered that better than a wash.

Rabkin's fee is a bit higher now, but the same percentages apply, as far as I know.
Samaro ..
on 11/19/11 10:19 am
Dr. Crookes is the only vetted DS surgeon in California who doesn't have a program fee or other up-front fees beyond insurance co-pays.

As Stacie said, he only does the DS open, but to those of us who have had it done open it has not been a big deal.

Dr. Crookes will ask you questions to make sure you have a very good understanding of how much care and maintenance the DS requires.  Some people interpret this to mean he doesn' t like the DS or that he is trying to talk the patient into a different surgery.  He's just trying to make sure he does the DS on people who are going to benefit from it rather than be harmed by it (by not taking appropriate care of themselves).

If you decide to use Dr. Crookes there are many of his patients on this board who will be happy to talk with you about him.







Ms. Cal Culator
on 11/19/11 10:25 am - Tuvalu


Yes...and he's got an excellent reputation as a DS surgeon.

I just hadn't noticed as many Crookes patients as I used to see.


2011Mommy
on 11/19/11 10:57 am
Thank you! As much as I wish money was not an issue- it is. Of course, I would never choose a surgeon simply because it would save me money so to hear that a vetted DS surgeon (and one that gets many positive reviews) is within reach gives me hope (and a big, silly smile)... I appreciate the feedback.
teachmid
on 11/19/11 11:07 am - OKC, OK
I totally understand the financial side of life, but make sure you can afford your vitamins and labs.
     -Gail-
SW  257    CW  169  GW  165
  
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