NEMC

what kind of post op appointments are you talking about? Why would insurance approve surgery and then not cover the post op appointments. It doesn't make sense to me at all. Don't the insurance folks no that surgery and post op appointments go hand in hand???? I'm confused.....I think I will call them and ask them. Does anyone here have Tufts Navigator and have to pay for their post op appointments.....( I don't mean the co pay). Thanks!

Hi The fee covers many things not covered by insurance, not only the dietitian but also the administrative time, nurse or PA phone calls, support groups, pre operative weight loss groups, etc. Interestingly, insurance companies dont pay the full amount that is billed, so a Doc, nurse, or dietitian may bill 80 dollars for an hours time and they might get 20-30 paid by the insurance company. You cant bill for phone time or admin cost and you cant jack up the cost of a MD visit to cover these costs. Some insurance companies cover dietitian visits, some do not. What happens is many people dont follow up after surgery for their nutrition visits because they arent covered, which is unfortunate, and needed. So, dont blame the hospitals, most all hospitals have program fees in this area. The insurance company skims off the top too. It is definately unfortunate. Stella

Almost all programs have a program fee. Part of it is to ensure that patients entering the program are committed & serious. It helps cover administrative fees (like the groups, lectures and your meeting with the exercise physiologist). I went through NEMC and felt it was money well spent. Btw, my insurance is BCBS and they reimbursed me $150 of that fee through their weight loss reimbursement program. You can find more info here if you're interested: http://www.bluecrossma.com/Medicare/audience/Provider/wellness/wellness_weight_loss_benefi t.html?&iphl=weighting:hospitals:weighted:hospital:weights:weight:losses:loss: