FRUSTRATED W/ OSU

Hi All~ Happy Valentine's Day! I am very frustrated with OSU and their whole program, I went thru and just completed the 3 month supervised Living Well Class, which I had to pay $300 for because I have AETNA and they aren't in network. Now that I'm finished I received appointments with Kris Fout-Registered Dietian and Dr. Kramer for a PSYCH evaluation. The dietian is covered under AETNA but Dr. Kramer isn't and to see him just the one time is going to cost me another $415 due appointment day, because he don't take AETNA either. I called AETNA and they can't believe that Dr. Needleman's office is referring and REQUIRING me to see out of network providers. Dr. Needlemans office says they USED to let people see other PSYCH doctors, but now NO IF'S, AND's, or BUT'S- I have to see Dr. Kramer or go to a completely different Bariatic Physician. I've tried calling Dr. Currys office in Cinncinati, because of all the great things I hear about him on this site, but never get anyone just an answering machine......maybe I have the wrong numbers......anyone have a number to try? I've tried 513-559-2545! Has anyone else dealt with OSU in this matter? I know I should suck it up and pay the money but heck that is why we pay $127.50 a month to have AETNA. OH then I'm told I have to pay another $100 for the 4 week classes on how to eat AFTER surgery. I can deal with that one but that is a total of $815 out of pocket and still no guarantee of insurance approval!! Any suggestions would help!! ~~Tabitha~~

WOW...Tabitha! I had surgery at OSU and have Aetna insurance. When I went through the program my insurance would not pay for the psych evaluation b/c of something with it was for a medical condition and not a mental condition? I paid $75 and had 2 consults...the appointment and follow up. I also did my dieting classes here in my hometown local hospital. I had the choice to go to OSU or go local and b/c of having kids it was easier for me to stick close to home. Have you talked to Shannon Shurber at OSU about this? I would give here a call and maybe she can explain to you WHY they are doing this. I realize you are frustrated and I don't blame you. It is very aggravating to pay for insurance and then have to pay out even more money. Then on top of that wait to see if insurance will pay. However, if you have reviewed your insurance program plan and you know what they expected in order to get approva you should be ok. Stay positive....I know its hard at times. In the end it will be worth it! Karie -131

~Thanks everyone for your responses, you've been very helpful.~ I did, Karie, talk to Shannon @ OSU~she is so nice and helpful~ but that is what she told me........DR. Kramer, or got through another program. I also checked with my insurance company(AETNA) requirements before contacting OSU, I just never imagined that OSU would now REQUIRE me to go to a PSYCH doctor that is out of my insurances network and it would cost me $415 up front, they don't even take payments. and I can't go to another Doctor(psych), I would think they would have an alternative doctor that does take Aetna. IT just don't make sense to me. The thing is they knew what insurance company I had when I mailed in my application last 9/04 and never said anything to me. They said they used to let patients see what ever psych doctor they wanted if insurance didn't cover a certain doctor, but they no longer do this. I do however have an appointment next wednesday 2/23/05 that I just made today with Dr. Curry in Cinnci. But just found out while doing a search of their website they charge $125 just to join their program! I'm calling their insurance coordinator tomorrow to see if the dietian and psych doctor they will have me use take Aetna, that way I have NO SURPRISES!! $125 is alot better then $415, not counting the 4 week dietian classes for after surgery eating.........I don't know what that costs???? Karie~ Its hard to believe you paid only $75 for to visits and now it up to $415 for one!~DId you go to Dr. Kramer?~ Thanks again Tabitha

I know what you mean about OSU. My sister first tried with them over a year ago. She wieghs almost 360 lbs and was diagnosed with fibroid tumers in her uterus. The surgeons there wouldn't remove them because of her size an said she should lose weight first. Needless to say they sent her through so much stuff and money. And she was still waiting for there approval. She has medicade and medicare. A friend of ours in Dayton told us about her surgeon Dr. Alison Clarey (937)439-4145 Fax (937)439-4196 daytonbariatriccenter.com and she and I went a little over 6 weeks ago. Two weeks after the info. session which is mandatory we were both approved. I have medicare and will have to pay $313.00 of my own money where as my sis won't have to pay anything. I am not sure if they accept Aetna or not. But I am going there tomorrow to the hospital for our pre-admission testing. And I will find out about the Aetna insurance for you. My sister now will be able to have the hysterectomy she really needs this summer once the weight starts coming off. She was so scared waiting on OSU that she was getting really depressed thinking by the time they and medicare/medicade approved her she might develope cancer. So I know what yiour going through with OSU. I weigh 250 lbs and have joint problems with my back and knees because of the added weight. I've gone through so many treatments for the pain and painkillers. I've even paid to get the Dr's history online to see how the physicians board rates her. And I am pleased with the results I found out about her. And also that I know several people who have used her. So give them a call.

Dr. Bruce and Dr. Clarey did my surgery in Sept. and I have never been in better hands. They did an excellent job, the staff at the hospital loves them and I felt so at ease with them. I am on medicaid as well and they got me thru right away. I would recommend them to anyone. Doreen

hey i had put a post up today about needing help to find a medicaid provider and and recieved this in response i did call the number and got a return call within 20 mins and the people i talked to were very sweet and helpful and i notice the number i called is different then the one you have so i hope this helps i talked to tracy on her direct number so try that one first cause she can also help with the insurance part believe me i understand that i have to pay 350 a month for medicaid and just got home from the pharmacy with 200 in prescritpions they don't cover medical expenses are crazy nowadays do what ever you can to save yourself a little Autumn My name is Tracy and I am the Insurance Coordinator for Dr. Trace Curry's office in Cincinnati, OH. We are located inside of Deaconess Hospital at 311 Straight St. We do accept Ohio Medicaid. If our location is not too far for you to drive, we would love to help you out. My direct number is 513-559-2544. I am in the office every day but Tuesdays. My hours are 7am-3:30pm. If you would like to call outside of my hours, you can call our receptionist at 513-559-2545. She is here Mon-Friday 8:00-4:30. I hope to hear from you soon!

Don't give up on Dr Curry's office just because you get the answering service. Just try again and at least leave a message. They are really wonderful there. Tracy has really worked hard for me and even when I could not get the surgery done she sent me information to look at and to go over. She will do all she can to help. Dr Curry is wonderful too, not to mention he isn't bad on the eyes.....lol, so don't give up. Shelia

Tabitha, Keep trying Dr. C's number. You won't be disappointed! Beth

I am really sorry you feel that way. But to be honest, your insurance is one of the worst ones there are as far coverage and what they actually pay the providers. I work and have worked with many different insurance companies in my years of nursing. However..... You should feel lucky that you only have to come up with that amount. As OSU employees, our insurance requires this: approx $5000.00 out of pocket up front before we see the MD a separate $400 deductible that has to be met first a $250 hospital in patient co-pay 1 YEAR of Living Well classes I believe the cost for 6 months is $650 4 weeks pre-op teaching which is $95 (they will only reimburse a certain % of the both combined) Plus the psychiatric evaluation Nutritional Consult Lab work, ekg, chest xray. Now, that's after you get approved by the department. Then our insurance sends us this nice little letter outlining the above. We have a very comprehensive program here. Our goal is to make sure that you are going to be successful after surgery. Dr. Kramer is trained in this area, because unfortunately there are psychiatrists that just give one or two line evaluations and they really don't make sure that people are mentally ready. I would say most of the people who fail do so because of psychiatric problems. Usually with substituting coping mechanisms, and modifying behaviors. This is why you must see our psychiatrist. It has nothing to do with money. Look at what we as employees of OSU have to go through. And that has absolutely nothing to do with the Bariatric Dept. They had no say in that at all. Feel fortunate that you only need to come up with about $800. Anything worth having is worth working for. At anyrate, I wish you luck in your endeavors. Valerie Curry RN OSU OB/GYN Dept of Maternal Fetal Medicine Research Nurse Lap RNY 07/10/2003

Thanks Valerie for the insite.....I guess my thing is I would think that there has to be at least 1 doctor in COlumbus that is qualified as well as Dr. Kramer to do these evals. I know Aetna can be a pain w/ their pay-outs, but that still don't hide the fact that less then 6 months ago OSU was letting patients that have Aetna or Aethem see someone else because Dr. Kramer don't take their insurance. I guess I would think they would have at least 1 back up to Dr. Kramer!! I have looked at my options, contacted different places and most of them require you to have a Psych eval.....I have to anyways, Aetna requires it, but the one in Cinnci has 5 doctors you can go too that are specialized in this area, from what I was told. I just wish OSU would have options too.....heck who is to say Dr. Kramer is going to be around .....life can be short and you just don't know what will happen tomorrow. Then what will happen? I haven't cancelled my appointment with Dr. Kramer , I have enjoyed, so far, everything I've went through with OSU......even meeting with you, and Shannon has been wonderful on the phone with answering all my questions, which is such a big plus in my book. I have till next week to deside what I'm going to do, its just hard to come up with the $415 up front.....especially when they don't have any payment plans. Anyway thanks for the post~ Tabitha