Question:
My dr charges $4500 post-op aftercare, no insurance accepted for this. Sound fishy?
— Patti K. (posted on October 3, 2001)
October 3, 2001
Post-op after care (office visits, staple removal, etc.)is included in the
surgical fee the surgeon was paid by the insurance. It is referred to as a
global auth for surgical follow-up days. This means that after the surgeon
does the Roux-En-Y procedure, he cannot charge any additional fees for
follow-up care for the next 90 days, unless unusual complications occur. I
would suggest you find out a detailed description of what he calls his
"after care".
— [Anonymous]
October 3, 2001
Most insurance companies only get about $2000 - $3000 from the insurance
company for the approximately $12000 bill they submit. Many private
surgeons will charge a program fee to make up some of the difference for a
lifetime of follow up care. If you are having the DS, there are some
doctors that do not charge that fee, like Dr Anthone and Dr Crookes at USC,
since they are affilated with the university and therefore are not allowed
to charge a separate fee.
— Anita N.
October 3, 2001
my drs fee for was 4000. this included the pre-op, surgery, and the post op
care for up to four months.
— paula B.
October 3, 2001
This is becoming more commonplace with the recent increase in popularity in
this surgery. More docs are specializing in WLS and more docs are padding
what they receive from insurance with these sort of fees.
I would find another doctor. Especially if he is trying to justify it with
some BS reason other than he just doesnt think he gets paid enough by the
insurance companies. It is dishonest and greedy. If he doesnt think he gets
paid enough for his surgeries... maybe he should become an accountant or a
real estate agent. I dont think I make enough money either but if I charged
my clients a premium they would go elsewhere.
— SusanMaria
October 3, 2001
That is some expensive aftercare!! My surgeon charged about $4500 for the
RNY and was paid about $1400 from my insurance company. I thought this was
quite a low reimbursement. I was never asked or expected to make up the
difference by paying an unreasonable fee. My original referral was good for
3 months and included my post op checks up to that point.(I never even had
to make a copayment) For my 6 month check up, I had my PCP call in a
referral and then I paid my $15.00 co payment at my visit. I have been
extremely pleased with the professionalism and lack of money
"emphasis" that my surgeon's office gives. In fact, I have never
even talked to my surgeon about his fee or my insurance reimbursement. It
appears that he has the well-being of his patients uppermost in his
motives. I would most definitely find another surgeon, this one is just in
it for the money--obviously. Shelley
— Shelley.
October 3, 2001
Just an FYI. When the doctor's sign up with an insurance company they
negotiate their fees in advance for particular procedures for that contract
period. If the doctors are not happy with their reimbursement fee schedule,
then why did they agree to it in the first place? When their contract is
up, they can always renegotiate for higher fees, or choose not to renew.
Don't let them fool you. They knew when they signed up with that insurance
company how much they were going to be reimbursed for every procedure they
do.
— [Anonymous]
October 3, 2001
Forgot to mention - if a particular surgery turns into a much more
complicated procedure than normally expected, the surgeon can file for
additional fees based on the complexity of the procedure. If he has the
documentation to back up his claim (the op report should contain all that
occurred during the surgery, and that is all he would have to submit) then
he can get a higher reimbursement from the insurance company.
— [Anonymous]
October 3, 2001
Boy--when i was reading all the posts as to how much your doctors charged i
nearly choked. I got the BILLS in the mail this past week. My doctors
submitted to my insurance a bill for $35,000. The hospital bill was
$14,770. Then came the anestheseologist (sp?) $1700. Thank God my insurance
is covering everything 100%.
— rose B.
October 3, 2001
I'm having the same problem with my surgeon and because I have a rather low
income and can not borrow the money because of bad credit I'll have to
pospone my surgery until I can save the money because they will not even
give me a date until the fee is paid in full, even though I've been
approved by my insurance.
— Diane B.
October 4, 2001
RUN AWAY!! FAR AWAY!! I was dealing with something similar but only $500.
(geeze, seems like a deal now), but still too much. My insurance pays 100%
and they still wanted the $500, so I found another surgeon in my area who
thinks that is taking advantage of desperate people, and I agree! Please
check around, you can find someone who will be reasonable.
— Lisa B.
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