Dr. Houston (Nashville), DS, & Medicare

I'm looking for input from post-op DS patients of Dr. Houston who are on Medicare.  I'm trying to find out how much I'm looking at total for copays (including surgery) to Dr. Houston's office.  The hospital files QMB, which covers all of my deductible and copays, but Dr. Houston's office does not.  From first post-op through your initial one week follow-up, can you tell me how much you paid to his office?

After doing some research, I've found that most provider's offices are grossly misinformed regarding the QMB (Qualified Medicare Beneficiary) program, which is a cost-sharing program administered by Medicaid.  A facitily does not have to accept Medicaid to file for payment of copays from the QMB program.  I'm sincerely hoping for some advocacy and education of clinics soon to make this program more functional.  My own PCP doesn't even file QMB, but they still take QMB clients and just write off the copay.  It's a waste, because they could actually be collecting that if they understood it.  Centennial is the first place I've encountered that knows what it is and accepts it.  My hands feel tied at the moment, because I want to push this topic with providers, but I don't want to do it at risk to myself not being have this surgery.  Dr. Houston is my third doctor choice because I've been fighting several different battles just to find a surgeon.  Thankfully, knowing what I know now, Dr. Houston is also my first choice and I'd pick him over the others if I was just starting the process.

I don't have any personal experience with this, but is this something that you could file yourself?

I would talk to the hospital insurance liazon and then ask them to talk to Lisa or who ever your insurance person is at DR. H's office. Make an appointment with Lisa and take all your paper work with you. They may be glad to receive the education and information.

That's a good idea.  I don't know if I can manage an appointment with her, unless I can get it on the same day as my consult.  At the very least, though, I'll talk to them about it either before or after, when they know me a little better, to help future patients.  As for reimbursement, all signs point to no right now, but I plan on calling the QMB number on Monday to find out for sure, and maybe even get some help with this.

Lisa is pretty easy to get an appointment with. She is your advocate. I would call and make it for 15-30 minutes before you dr. appointment. When is your consult? I would enjoy meeting you. I only live 25 minutes from the office and when I know I have other things going on down there I stop in for support group.

That's good to know about Lisa.  I've been emailing with a Lisa Ferrel at Centennial Center for the Treatment of Obesity to get all of my paperwork together.  Is this the same Lisa?  I don't have a consult yet, I'm still getting my medical records taken care of and I have my psych eval here in Memphis on Tuesday.  I will let you know when I have my consult scheduled.  Would love to meet you too!