Got my Surgery Date and a GIANT surprise!

Its been 6 weeks since they sent off for approval. So Monday I called. Today they called me back and SURPRISE its a approved. haha. Wonder how long ago it was approved. Anyways they gave me my preop date and surgery date (April 27) and then asked me when I would be paying the 2995 "program fee". I was shocked by this. As I have obviously saved up for the time I will be missing work, my hospital copay, and for a little extra. Why would I not plan or save up for this nearly three grand fee? I wasn't told about it when I started with this doctor in Oct. They were going through a major staff change at the time and I assume it was accidently overlooked. But still. That's a lot to come up with and for what? A few support group option pre op meetings. And to keep the protein powder and vitamins at cost. What?! Anyways. I asked why insurance doesn't cover and she said that no ones insurance covers it because it is a program fee and a non billable expense. I also asked if this was a new fee and she said no they have always had it. So I asked my neighbor who had surgery in last july at this doctor and refered me there and she said she never heard of such a fee. So tomorrow I am going to have to try to call to other surgeons in my area and see if any of them accept my insurance and how I could possibly switch over to them this late in the game. :-( Anyone ever have to switch sergeons? Anyone else have this random fee? I don't even know what to do. Its aready been since last August when I began this journey and I feel so defeated and close to just giving up! I want this so bad which is why I am trying to puch forward but I almost feel like the universe is telling me no time after time.

My insurance paid for my classes. But then the surgeon always did a five minute presentation at the end of each class after the nutritionist did her thing. I would definitely check on that, somebody's not doing their job in billing. 

This is a fee for post op. Like for support groups (optional) and to keep the protein powder and vitamins at cost instead of jacking it up. This was the explanation I was given today. My insurance has covered everything except my copays and hospital copay. Which I have budgeted for.

Let me get this right. They are billing you for services you haven't received yet? Is that ethical or even legal? What if you decide you don't want their products or attend their support groups?

So my main question is has anyone ever had to switch surgeons after the approval process by insurance?

I plan to call tomorrow to other surgeons and see if I can do this. But wanted to get an idea if its even possible in the grand scheme of things?

You might find a new surgeon to take you on  but I believe they would have to resubmit to insurance.  I'm not entirely sure.  I've seen it happen on these boards though where someone had to switch midstream, even close to the end zone.  I would also push back harder on your current office.  If you didn't sign anything saying your were going to pay I would say you don't plan on paying it, but you would still like the surgery. Sounds very fishy!

Yeah it is very fishy. I even said I had all the initial paper work from the supposed day she told me in front of my with none about that. She said its a verbal notification not a written one.

I was worried I would have to resubmit. I will just have to call in the morning to insurance and see what they suggest. I will then call other surgeons and see what they offer. And then call my current office. It is crazy that I know two people who had surgery with her and neither of them paid the fee. Both had surgery last year. But when I asked if it was a new fee I was told no that it has always been there.

My friend said it sounds like the surgeon is trying to double dip. By calling it a program fee for the support she offers post op. And billing insurance for her services as well. I pay a copay every time I go in.

Program fees are sometimes used to help cover the cost of a post-op follow-up with a nutritionist or to offset the cost of a therapist or psychologist to do the support groups, but mostly it is a way for surgeons to make more money.  

They say that they use that, in part, so you can get your vitamins "at cost"?!?  If you are paying the "program fee" and THEN buying the vitamins from them (and there is NO reason you need special, expensive "bariatric" vitamins, BTW), then you really aren't getting the vitamins "at cost" are you?!?

You may have to notify the insurance company that you are switching surgeons, but they have already approved the medical necessity so all they really need to do is confirm that the new surgeon (and, possibly, new hospital) is covered by your plan.  The new surgeon's office should be able to handle that. 

Lora

Lora-

Thanks for your reply. It really does help put my mind at ease. And obviously after having thought about this all day I realize how ridiculous the fee is and that it is really unnecessary. The fee doesn't make sense to me but glad to know it is not just my doctor (though hopefully there are doctors in the area without it that take my insurance).

I am just going to stick with calling the insurance and a few other surgeons tomorrow to see what I can work out.

Thanks again Lora and everyone *****plied. :-)

else *****plied*