Insurance Shminsurance

SO, I find out from one of the surgeons I am considering that there is a $7500 non convered service fee. Has anyone ever heard of this? The things listed were: Blue Cross Non-Covered Services Policy We feel the ultimate success of our patients following weight loss surgery is equally dependent on the surgical procedure they undergo and their commitment to our comprehensive postoperative support system. We expend a great deal of our time and resources supporting and tracking our patients after surgery. This support is critical in helping patients achieve the healthiest long term weight loss possible. This support goes far beyond the routinely authorized 90 day postoperative visits or other routine medical office visits. This support includes: Direct access to our Surgeons and Support staff Preparing for Weight Loss Surgery (30 pages, authored by us) Postoperative Dietary Guide (30 pages, authored by us) Photo documentation of your weight loss Graphics and flow sheets of weight loss Annual Laboratory Summary and follow up visit(regardless of insurance status) Postoperative Wallet Cards Surgeon/Support group leader attended monthly support groups Online chat room support MDpostop® our online patient tracking software for diet, exercise and weight loss Monthly Newsletter On staff Registered Dietician (two preoperative consultations required) Two weeks of postoperative protein supplements In order to maximize the chance of your success, we believe that weight loss surgery involves not only the operation but also the services detailed above. Unfortunately, your Blue Cross policy deems these services as non-covered benefits and will not pay for them. Therefore, we ask that you pay a Non-Covered services fee. This fee is not recoverable from medical insurance companies. You may refuse to pay the program fee and ask your insurance company to refer you to another provider for weight loss surgery. The fee is based on the procedure type and length of follow up required: LapBand: 5,500$ for 5 years(includes band adjustments) Roux en Y Gastric Bypass: 5,500$ for 5 years Duodenal Switch and Revisions: 7500$ for 10 years(necessary for complexity and higher risk) Is this something everyone does? AM I going to have to come up with this kind of money anywhere I go?

Jami: I have seen providers offer these "auxilliary" types of services for patients going through weight-loss surgery, but it is by no means common, especially if the provider is contracted with your health insurance company. Typically, if this provider is considered in network by your health insurance company, then all services that he or she renders should be done under the contract that he or she has with your health insurance company; thus, your only financial responsibility would be a co-pay or deductible, as evidenced by your health plan. If the provider is offering services outside of the contract, then you will need to find a provider that is going to be having the surgery per the terms of his or her contract with your health insurance company. You don't want to be responsible for any additional financial obligations other than what you are required to pay as a deductible or co-pay. Is this provider in network or out of network? If he or she is out of network, then the provider can theoretically charge whatever fees are deemed necessary. But, from the verbiage above, it sounds as if the provider is in network.

Yep he is in network....out of state, but in network. I know they are tyring to make more money off of me because my insurance caps out on WLS at $7500. I was just hoping that was going to be the exception and not the norm. Thanks for the response!

Jami: You might want to report that information to your health insurance company. In-network providers are required to follow strict contracts that they have with health insurance companies. I cannot tell you how many providers I have dealt with who have tried to illegally stick a patient with charges that are not part of the contract. Just think: contract means that your financial responsibility lies with either your co-payment or deductible--nothing else.

I will make sure and let them know what happened. I am going to another surgeon anyway....thanks again!