High Program Fees for Surgeons??

Hi,
I had my consult today with Dr K in Glendale, CA.  Apparently I missed the memo about the $4,000 program fee!  I am not used to this, as with my first Rny, since i had insurance coverage, the only thing I was responsible for was the copay...thats it!  Now I have great insurance which will cover the surgery, but they are saying that I still have to pay the program fee (which seems a bit high to me).  Anyone else have this roadblock?  Any other programs with great surgeons where the fees are LESS?  I called Dr Rabkin, but they are considered out of network so his out of pocket fees (even if you have insurance) are at a MINIMUM of $8200!!  WOW.

I am still excited about going forward to getting the DS revision done...just having a hard time stomaching that large fee!

Any thoughts?

I'm on disability with medicare and I still paid the 3k fee (I'm not a revision).  He and the DS are worth it.

The 4K was a shock to us as well but after mulling it over, checking with other DS surgeon's and having my family point out the obvious that my life/health is worth that much and more......I got the financing together (actually my hubby did) and went for it!!!!

I was a high risk case though and felt like Dr. Keshishian was the only guy for me!  He went into the O.R. all excited and to quote him,  "I can wait to get my hands into your guts"!!!  He's insane about his job, is a perfectionist (works to our advantage) and has an amazing history of success with hundreds of happy post-ops to prove his success.

There may be other Ds surgeon's who you can get to for less or maybe even nothing.  How about asking on the DS forum? 

Good luck with your journey friend!!!!  Keep us posted, K?!

 

My concern is that it seems that I'm paying twice for the same thing.  I was explained to that the Program Fee covers nutritionists, and all post op visits, etc.  MY INSURANCE PAYS FOR THAT! I could see if I didn't have coverage, but with FULL COVERAGE who will pay him IN NETWORK at 100%, I am not sure what I am paying this extra money for - ESPECIALLY when I won't be seeing him every few months post op.  I dont live in CA and I didnt plan on flying back every couple of weeks. I was coming to him for a few times post op, and then going to continue with my regular labs and have them sent to him from my PCP.  I will call back today and get them to explain if there is something that this program fee covers that insurance doesn't.  I know insurance won't pay for it, but I'm trying to really get an idea of EVERYTHING it covers so that I'll know.  In the meantime Im checking with other surgeons.  I am still getting the surgery though...but it may be somewhere that is a little more cost effective  =)

Hi What insurance company do you have? That seems so unusual that a Dr charges even more since the insurance company compensates him too. I am heading in the same direction as you, having had a rny in 02 and now have mechanical failure. I am going to have to change insurance companies and will be looking for one at open enrollment. I have medicare, am 65 and my husband works for the state and the state insurance doesnt cover any bariatric procedures or repairs. So I am technically screwed. I know the feeling of defeat and pain for sure. Carole

I have Regence Blue Shield.  They will cover the revision at 100% because I have met my deductible and I meet all of their other requirements.  I am looking at other surgeons who are equally as skilled - Dr K is great..but I don't feel I should have to 'prepay' for after care that can be easily billed to my insurance company and they will pay it right away.

I totally agree with you. If you find such a surgeon please post it so I can know too. thanks and good luck , Carole

I have to agree with you on this too, moreover it seems contradictory to the Dr's agreement with your insurer.  When a Dr. chooses to be a network provider, he signs a contract with the insurer saying that he will provide specific services at a contracted rate and in return he gets increased volume from that company's members.  So, to say that you must pay a program fee or you can not get the service is essentially saying he won't provide the service at the rate he agreed to with the insurer.  Dr's should be very clear, either you are in network and you provide the service as contracted for or you are not in network and you don't get the benefit of increased patient volume.  My original RNY surgeon had a fee like this back in 2001, he told patients that they had to pay $2,000 extra if they wanted their surgery lap instead of open, despite the fact the he had contracted with BC/BS and knew full well that the procedure code and reimbursement applied to open and lap procedures.  Long story short, about three years later he was forced to refund that fee to all the patients that had paid it and also lost his contract with BC/BS as an in network provider.

I'm pre-op RNY. However, the program fees surprised me too. Not the amount ($1,000) which I was allowed to pay for in three installments. Rather, my surgeon is in network, BUT since the services that the program fee covers are provided by individuals who are out of my network such as the behaviorist, NUT, etc. I couldn't get the fee paid for in network. They billed my out of network which I didn't realize until I saw a post on here that dealt with the "hidden" costs or surgery that's it not as clear is things seem.

Know what's in network and out of network. I found out that they weren't billing me twice. Rather they were billing me for in-house providers who aren't in anyone's network. The surgeon visits were covered in network and only got billed once.

Blah blah.

Good luck!

/pea