Question:
I went for a consult with Dr. Waits a few months ago....

my insurance denied coverage but am getting new insurance in January so I called them today to see if I can get back in the process but was told that starting in January they are charging a $4500 program fee!! I asked the nurse if that was legal and she was pretty defensive stating that they were only making $1200 per surgery with insurance paying and they have to do this to make ends meet! She said other docs in Atlanta are doing the same! Anybody out there had experience with this? I find it unbelieveable! She said insurance will NOT cover this. I hope this is not going to happen with all the practices. Pam — Pam B. (posted on December 9, 2002)

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December 9, 2002
Well I would be defensive too, knowing the charge will prevent needy patients from getting surgery. I suggest you contact the media, newspapers, TV etc and tell them about this. Certinally comment here about your doc, this proifile will be read by others. Your the second poster to come here about this, and as I said earlier the charge will spread. Your surgeon appears to be a wonderful and good but VERY GREEDY. Heres the prevoious discussion about this. http://www.obesityhelp.com/morbidobesity/question.phtml?N=1039015297
— bob-haller

December 9, 2002
How sad to see that even the medical world has come to this. I have seen things like this after a hurricane or tornado hits an area and people are charging 3 and 4 times the value of generators, building materials, etc. It all has to do with the law of supply and demand. It also has to do with the greed of humanity. Not only do they want the money from your insurance company, but they want to squeeze you dry, too. If I were you, I would run real fast from this surgeon and find a new one. It is clear that money is more important to his office than the health of his patients. P.S. The reason insurance will not cover this fee is because your insurance company has pre-negotiated the cost of this procedure with this surgeon. Why is it all of a sudden not enough? They might find it interesting if you told them about this so called "fee". He may be kicked out of the network if they find out about it.
— Wendie G.

December 9, 2002
Pam why not call a tv station or newspaper and see if they will do a investigatve report on this terrible practice, Under the glare of medias atrtention and public opinion you might get them to reverse this cruel decision or at least get other surgeons to think twice before doing it themselves If this were for cancer patients would the charge be allowed? Sorry Mrs Jones you have cancer, before we begin treatment wheres your $4500 program fee? Truly how is this different than MO?
— bob-haller

December 9, 2002
Hey, why don't we try for some national exposure on this. Send an e-mail with the details to Al Roker via his web site or directly at [email protected]. Maybe he can get his buddies in the NBC News Division to do a story on this for Dateline NBC or at the very least MSNBC Investigates. Also, call one of the local TV stations as Bob suggests. Try for one of the Consumer Affairs reporters - they love doing stories like this. We had a problem in the Philly area with this company producing these supposedly high-protein cakes called "The Original Protein Cake" which were sent out for testing and found to be not much more than regular pound cake. The nutritionist that runs our support group called NBC10's Consumer Affairs report in Philly and she came out last month to film a report on this and interviewed the nutritionist and a couple of my fellow support group members...JR
— John Rushton

December 9, 2002
Pam, I am working to get approve for the surgery and I am going through the same thing. I agree that something needs to be done to "nip this in the bud" but at the same time you should really find another surgeon. Through our complaints the fee might change but I wouldn't want to trust any part of my health to individuals that I did battle with over money. My situation seem to be similar to yours in regards to UHC and Dr. Duncan so I can understand the frustration, but stay encouraged. As you will see from furture responses, we have great support on this site and they generally :-) give excellent advise. Find another surgeon. Vesta
— vesta D.

December 9, 2002
Al Roker would be awesome. Imagine the greedy surgeons coming to work and finding 60 minutes waiting to question them? Lets do it! Do these docs have a website?
— bob-haller

December 9, 2002
This just blows me away. My insurance paid my surgeon about $1,500 dollars for his 1 1/2 hours of work. I know that is not a lot of money, but it takes me about a month to make that much as a school teacher. I also know that some surgeons have very extensive after care and education programs, but I saw my surgeon for about 2 minutes at 2 weeks, 6 weeks, and three months. For most anything that came up I saw my PCP. I agree with the other poster, what kind of outrage would you hear about if it were any other disease. I am sorry, but if they don't want to take the negotiated fee from the insurance company, they shouldn't be on the plan. I am also appalled that the cash pay patients are charged so much more than what the insurance companies pay. I mean really, they pay it up front, there is no financial risk involved.
— cindy Q.

December 9, 2002
Pam, I would suggest you expose this, I like the Al Roker ideas. You should also go ahead and see another Doctor. There are alot of great doctors out there that are truely concerned with helping you and not focused on padding their pockets. I am sure they get padded pretty well though. Good luck. You can do it!
— Ronda M.

December 10, 2002
Thanks for all your responses! I know these are 2 of the best surgeons in Atlanta but I still feel this is unethical. I read the original question from 120902 that Vesta posted (thanks Bob for adding that, I had missed it) and was quite surprised at the defensiveness of a few posters. Personally I feel that this practice will not be able to sustain itself now... when the majority of patients are only able to have this surgery by having insurance pay for it, who has $4500 to spare? Certainly not me! And certainly not most average folks... I think they will see a huge decline in demand for their docs. Time will tell. Meanwhile, we in the Atlanta area are fortunate to have several others to choose from, it just worries me that more of the better known ones may implement their own "program fees". Pam
— Pam B.

December 11, 2002
Dear Pam, I am sorry that you did not receive a more in depth and appropriate response to your concern regarding program fees and it's intended use in bariatric offices offering more then the surgical tool to accompany a patient's weight loss experience. Dr Wait's office has committed to offering their patients more then simply weight loss surgery. The surgery itself is covered by the insurance and is not included in the "program" fee. Dr Wait's office, not only, expects their patients to "obtain" successful weight loss -but to successfully "maintain" their weight loss. Dr Wait's understands that weight loss surgery alone will not "cure" a patient of obesity-related issues. It is one tool among many needed to support a patient willing to maintain their weight loss long after their weight loss surgery. The program is designed to support the patient long after the surgical procedure is complete. Some surgeons will provide an excellent surgery and stop there. Other surgeons, like Dr Wait's, want to provide aftercare for the years to follow. We have learned that weight loss surgery works. We have also learned that long term weight loss maintenance takes a personal commitment on the part of the patient. Dr Wait's understands that some patients are not equipped with the additional tools to maintain the weight loss that the surgery helped them to obtain in the first place. Recognizing that many patients cannot easily find bariatric specific mental health programs, diet and exercise programs, support and educational programs...Surgeons across the nation have taken on the responsibility of helping their patients help themselves. The program is a "bonus" if you will...it is an added tool that many Doctors across the country have realized is necessary to support the patients they care for. Many surgeons provide programs and include their fees in the way they feel is most appropriate to their patients. Once again, these programs are designed to support patients before and after the surgical procedure. The program involves educational, psychological, dietary, exercise and medical support. It offers preoperative and postoperative assistance to the patient who is committed to their long term success. Due to the extent of the programs offered by surgeons who are interested in helping their patients -long after the surgery itself is over-there is not only a financial commitment involved but a personal commitment as well. If you are one of those patients who is not looking for the "full program" approach and is content or satisfied with receiving an excellent weight loss surgical procedure -Georgia has some terrific surgeons willing to meet your specific set of needs. However, if someone -like me - is seeking more then one tool to conquer his or her eating issues - A full program approach may just be worth the investment.
— Teri H.

December 11, 2002
Boy, what a bunch of propaganda there by Dr. Holtzclaw. I'd say that most surgeons performing WLS out there have similar services available to their patients - without the $4500 program fee. By the way, out of all of the books that I bought on Weight Loss Surgery, I found The Magic Pill the only book that was a complete waste of my money.
— John Rushton

December 11, 2002
Hi Pam. PLEASE PLEASE PLEASE do NOT waste your money on this program. There are SEVERAL great surgeons in Atlanta and around GA. that have wonderful support groups that are FREE to all. I agree that having support from post-ops is very important, but I would never pay for that "service". I was almost sucked into Dr.Waits propaganda(sp?) but am so glad/greatful I didnt fall for that crap. I found a better surgeon and am glad that I changed ASAP. Trust me, you will be glad also. Open RNY 10-23-02 down 33.
— Siddy I.

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