medicare medicaid plus pay aftercare self pay in cash preop?

 I am medicare medicaid and they will cover R and Y by my understanding . I meet the doctor this week.

However, I was just talking to my neighbor who  had medicare also but he had to pay Dr GastricBypasser $3000 upfront before he'd agree to operate  ....not to leave a deposit on medicare or the like - but as a token of his sincerity about attending the aftercare program that is a support group, exercise, dietary ... yada yada. Which he'd have to pay anyway so said the doctor. 

This set off warning flags in my mind. Is this reasonable to expect

There is a surgeon here in So Cal that has a 3-4000k program fee for aftercare. Research the program fee- you can read all about it. You can definitely find an RNY surgeon who does not charge the program fee, though.