Unwanted opinions

Everything correct except, he did indeed receive $600.  That was the final amount after contractual agreements.  I believe it was an evaluation for severe reflux by a specialist which she did not have and never did.  She did later, for a slip but not at that time.  She had a fill under fluoro.  The extended office call, fluoro exam for reflux she did not have was settled at $600.  The primary fill that she was there for was never mentioned.  It was never mentioned she had a lap band.  The ins co was told she was there to see a specialist to evaluate reflux.  She was there as a band patient with no reflux for a fill.  Her ins did not cover fills.  It did this time and for each additional fill/unfill.

Had she paid ca**** would have been $100 a visit.

Everything else, yes.

Oh please-  I am not being technical and let me state clearly - if a patient comes to my office for an adjustment we have a specific charge. There is no Karen - that is a made up name, a made up situation. No Karen, no $600 bill. And yes, I asked my billing company do we bill anything for that amount related to a band - or in conjunction with a band - didn't happen.  But the accusation was that I billed an amount- and you are correct, what we bill and what we receive are two different things.  For example, with some insurance companies they pay us a set amount and we see the patient as often as they want for the first year. We bill them, but they have pre-paid for all services.  So yes, I could charge $1000 for an adjustment to an insurance company and they'd probably pay the same amount they usually do - or consider it part of the pre-paid package. What I was accused of was fraud - and when someone does that I am happy to ask for more specifics - but they could not come because this situation was simply made up.   But to be clear - there is no "Karen" in my practice that has the profile that ibd or whoever that is states. None. I am not being technical or evasive.  So kindly stop with the accusation that is unfounded from a person who has some agenda against me and yet has only accusations and no facts, and thus far on the one simple one- ibd just doesn't have it right. 

In terms of using the first 90 days- that is the most common period for which all rates of complications are kept. We can look at 90 data since everyone has that.  This is also the time when the highest mortality and morbidity occur.  You wish to look at long-term stats - we can, those are well published. That is not fiction - that is how we do it. But the 90 day data is clear- when insurance companies who sell insurance for cash patients they charge much more for a sleeve than a band, and they offer five year insurance for a band, but not the sleeve. 

You talk long-term data, bring the data. I'll put some data up about this- but be clear - an anecdote is not a series.

OMG!  This is like beating my head on a block wall.  We will try this again.

Would you agree there is a difference in price that your office charges for a band fill vs. a specialist visit for a specific medical problem and diagnostic xrays?  Would you agree this is the case?

Now, read slowly Doc, I wrote:

The ins co was told she was there to see a specialist to evaluate reflux.  She was there as a band patient with no reflux for a fill.  Her ins did not cover fills.  It did this time and for each additional fill/unfill.

Had she paid ca**** would have been $100 a visit.

And you responded:

And yes, I asked my billing company do we bill anything for that amount related to a band - or in conjunction with a band - didn't happen.

Are you seeing the problem here yet?

Now, you can continue dodging the question, changing the question, pretending someone asked something they did not ask.  It doesn't change the patients primary complaint, reason for office visit, EOB, and Insurance check cashed.

I simply do not lie.  It isn't my style.

There is no Karen who fits what you describe.

We do not put reflux in as a diagnosis for an adjustment.

If someone get an upper GI  - they sometimes use the code for reflux- however, I don't own the imaging center, have no idea what the imaging center does or bill and that is not me- that is the imaging center. That is not me. 

I realize patients get this confused - but while I may order an upper GI to evaluate the band- the imaging center (not me) may bill the insurance however for whatever code. So on the EOB my name may be attached as an ordering physician but the reimbursement for that does not go to me.

OMG OMG OMG!!!!!!!!!!!

Okay, you win.  I honestly don't know why you can't grasp something as simple as the concept that you didn't f'ing BILL for a FILL, you BILLED FOR REFLUX.  REFLUX SHE DID NOT HAVE.  Seriously, what is confusing for you?  How can I dumb this down further for you?  

Regardless, I don't know if you are being obtuse or if something is wrong with you.  Either way, I think you have done your job well here.  Please do keep up the good work.  It would be in the benefit of patients.

I really enjoy your posts and all of your help, but on this one I disagree!    I have had rotten weightloss with this band, have kaiser and they don't like to revise, so with that said I am learning from reading his posts!

I am always open to hearing the good, bad and ugly as long as it is done in a clear manner!    Since I have this thing in me for now,  I want to read and know as much as possible.   I am learning a lot from him!

Again, I always love reading your posts!

What the heck are you learning from him?  He hasn't offered any advice other than it isn't  restrictive, if you don't like bands go away, and if you disagree with him this isn't your place.

Seriously!  What have you learned from him?  

First, my post was not to you!  

Second, the way you attack with your posts you really think I want to share what I have learned?

As you said, "SERIOUSLY!"

I come here to learn then make my own choices!  I am not here to waste my time with verbal B.S!

Ann

Ok, I just got here..... who is this dude???  lol!!