Program Fee

Tell me Please, why do we have to pay a program fee to the doctor if the insurance is covered by your insurance. Why do they want 4 or 5 thousands on top of what they get from your insurance. Is this something that all doctors require. I live in the SF bayarea. I was told by 2 doctors that my insurance would cover the revision but they want 4 and 5 thousand extra.

The REAL reason?  Insurance companies pay so little that the doctors can't afford to DO the surgery and follow up without a "supplement."  So they dress it up and call it a Program Fee.  

Not ALL doctors in CA charge the fee...Rabkin doesn't...however, from what I understand you pay him all the money up front and then he refunds whatever your insurance does pay.   When I had my revision, Keshishian charged $3000; I think it's $4000 now.  I wasn't thrilled, but when I saw how little BC paid him, I felt that I had at least paid a fair amount.

If you can't handle the fee or the up-front payment, there's Crookes in L.A.  But by the time you pay for all the travel and hotels and all that...it could cost just as much.

Sorry,

Sue

My surgeons fee is $700.  I live in South Florida.  He states it's for follow up, support groups, etc...personally I'm sure it's just another way to make some extra funds.  When I had my initial surgery there was no such thing, insurance paid for everything but my copayments.

I am lucky I guess; no program fees for the band (in 08, removed over a year ago) or my RNY (almost one year out).

Pure and simple, extra profit because they can.  There are plenty of surgeons who do not charge these extra fees and follow the agreement they made by contracting with your insurer.

  If TTT is considering the DS in California, there is ONE doctor who doesn't charge a program fee.  One. 

Please let me know because the doctors that I'm talking about is Dr. cirangle and Dr. K . I have seen them both and I know that they're great at what they do,but I myself and other cant afford 4 or 5 grand.

 Crookes at USC in Los Angeles.  I think he does revisions, but I don't know for sure.  (Also, you have to convince him that you know EXACTLY what the surgery is all about.)

 TTT, are you talking the DS?  Because there is ONE DS surgeon in Ca who does not charge a Program Fee.  The others almost HAVE TO, because they get paid the same for the DS as they would for the RnY...and it often takes a lot longer and most of the DS surgeons are pretty involved with follow-up and that doesn't hold for al the RnY places out there.

I've been told that charging a "program fee" is illegal if the doc is in network with an HMO.  My experience has been to run the other way when the doc asks for a program fee.  This is not a good sign.  Most other patients in NJ agree, program fee = bad sign.