program fees?

Just wondering how a doctor can charge program fees when he is covered under my health insurance and my total out of pocket expense is only supposed to be $200. He wants to charge an up front program fee of some $2000. houldn't this be billed to the insurance company?

Unfortunately, most insurance companies have worked out to pay a certain set amount for the surgery, and it's usually less than what the surgeon/hospital/anesthesiologist normally charges. So, they sometimes try to make up the difference (*ahem* line their pockets) by charging program fees, surgeon's fees, things like that.

There are surgeons who do not do this. My surgery will be covered 100% by insurance with no upfront fees. Shop around for a surgeon who's not in it for the $$.

You doctor is in this for the money--no matter how the "program fee" is rationalized.  You can find another bariatric surg. that will accept what they have negotiated with the insurance company so that you don't have to pay out of pocket for any more than your $200!

Good luck...

If your surgeon is a network dr with your insurance he should be submitting the claim and you should only be responsible to your portion whether its paid at 100% or you have copays deductibles or co-insurance.  Check with you insurance company 1 to see if you have WLS coverage, if so then check to see if your surgeon is a participating network provider if so then tell them that he is asking for this money up front.  Most times they are not allowed to bill the patient up front until they know your benefits etc.

Vicki

He is in my network and my insurance does cover WLS. If you got to his website, which his name is Dr Hazeem Elariny located in Virginia it outlines that the program fee which is due at your 1st visit is $2000. Take at look at his website if you would and see what you think.


Thanks

Can you provide me the link to his website please

Have you been to Dr. Elariny's free information session? I have (in August), and he said he no longer requires the program fee for all of his patients. He used to, and it covers things like follow-up sessions, but he came to realize it wasn't really fair since not all of his patients were local enough to use everything the program offers.

So, call his office and ask about this specficially--don't just go by what the website says.

Thanks! Can I ask why you chose Dr Schweitzer because there is a possiblity I may use him?

I am getting the Duodenal Switch, not the RNY gastric bypass, so my options were limited. Elariny and Schweitzer were the nearest (Elariny is much closer). With Elariny, no matter what your insurance is, the DS is automatically out-of-network, whereas with Schweitzer/Johns Hopkins, my DS will be in-network. I did a lot of research on both surgeons and would have felt in good hands either way. I would have preferred to stay closer to home, but for what would likely end up being a few thousands of dollars out of pocket, I went with Schweitzer to save the money.