finding a surgeon

[Guest guest]

I would contact your insurance and explain what is going on and see if they will work with you. Explain why you need that surgeon and what the surgery is for. It never hurts to try and see what they will do.

[Guest guest]

Corri --

Have you checked with your insurance regarding referrals? I know with Blue Cross, if you have a referral from your primary care provider, they will cover a non-participating surgeon at the same rate as a participating surgeon.

Another thought is to check if you have a Maximum Out Of Pocket amount. Even if you end up paying the 30% rate for the surgery, once that number reaches your MOOP limit, they'll pay 100% of the charges.

Plus, the costs associated with the surgery are multi-sourced. The surgeon is one cost, the anesthesiologist is another cost (most people never know who this will be, and they don't consider whether he's in-network or out-of-network), and then the hospital itself is yet another cost. If your surgeon is out-of-network but the anesthesiologist and the hospital are in-network, you'll pay the 30% for the surgeon and your regular network co-pay for the other charges.

It all depends on your insurance company and your policy and which doctors/hospitals participate with your plan. And then there's always the option of filing an exemption request with the insurance company -- if there are no thoracic surgeons who are highly qualified to do this procedure who participate in your network, they may give you an exemption to the network requirement (it's cheaper for them to pay more to do it right the first time instead of paying less the first time and then having to pay for more work down the road).

One thing to look into is whether or not The Cleveland Clinic is a participating provider with your insurance. I'm over in SW Michigan and I'll still be going to Cleveland to see Dr. Rice when my time comes.

Debbi

Finding a surgeon

Hello All,

It has been a long time since I have written anything in this forum, but I read it daily.

I have been scheduled to have a consultation with a surgeon in Michigan for my Heller Myotomy. I have been scheduled with an excellent thoracic surgeon at the University of Michigan. I have just found out that this surgeon is out of my insurance network, wich means I have to pay 30% of the costs.

Does anybody know of a great surgeon in Michigan, or how much this procedure usually costs?

Any and all of your help is greatly appreciated.

Thanks so much All!Deborah Lattimore <deborah_Lattimore@...> wrote:

achalasia wrote:

[Guest guest]

Thank you for the information Debbie. If your insurance covers Dr. Orringer you should really check him out. His credentials are unbelievable. If you go to the Uof M surgeons website you can read all about him. Thanks again.Debbi Heiser <imahockeymom@...> wrote: Corri -- Have you checked with your insurance regarding referrals? I know with Blue Cross, if you have a referral from your primary care provider, they will cover a non-participating surgeon at the same rate as a participating

surgeon. Another thought is to check if you have a Maximum Out Of Pocket amount. Even if you end up paying the 30% rate for the surgery, once that number reaches your MOOP limit, they'll pay 100% of the charges. Plus, the costs associated with the surgery are multi-sourced. The surgeon is one cost, the anesthesiologist is another cost (most people never know who this will be, and they don't consider whether he's in-network or out-of-network), and then the hospital itself is yet another cost. If your surgeon is out-of-network but the anesthesiologist and the hospital are in-network, you'll pay the 30% for the surgeon and your regular network co-pay

for the other charges. It all depends on your insurance company and your policy and which doctors/hospitals participate with your plan. And then there's always the option of filing an exemption request with the insurance company -- if there are no thoracic surgeons who are highly qualified to do this procedure who participate in your network, they may give you an exemption to the network requirement (it's cheaper for them to pay more to do it right the first time instead of paying less the first time and then having to pay for more work down the road). One thing to look into is whether or not The Cleveland Clinic is a participating provider with your insurance. I'm

over in SW Michigan and I'll still be going to Cleveland to see Dr. Rice when my time comes. Debbi Finding a surgeon Hello

All, It has been a long time since I have written anything in this forum, but I read it daily. I have been scheduled to have a consultation with a surgeon in Michigan for my Heller Myotomy. I have been scheduled with an excellent thoracic surgeon at the University of Michigan. I have just found out that this surgeon is out of my insurance network, wich means I have to pay 30% of the costs. Does anybody know of a great surgeon in Michigan, or how much this procedure usually costs? Any and all of your help is greatly appreciated. Thanks so much All!Deborah Lattimore <deborah_Lattimore@...> wrote: achalasia wrote:

[Guest guest]

Thank you, I am sure it is worth a shot!m4myjn5@... wrote: I would contact your insurance and explain what is going on and see if they will work with you. Explain why you need that surgeon and what the surgery is for. It never hurts to try and see what they will do.

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[Guest guest]

I don't recall that name from any achalasia research.... what kind of experience does he have with this specific procedure -- the Heller Myotomy (how many does he perform each year)?

Even though it's considerably closer than Cleveland, past personal experience has scared me off from UMMC for achalasia treatment. Dr. Nostrant (GI dept) lied to me about some things and misled me about some others, all of which left a very bad taste in my mouth (no pun intended). I have to trust the doctors cutting me open, and I have that trust in Dr. Rice that I don't think I could get from a colleague of Dr. Nostrant. On top of the trust issue is the experience issue -- Dr. Rice has done hundreds of Heller Myotomy procedures, and he has worked side by side with some of the most experienced achalasia doctors in the country.

I hope you're able to get something sorted out with your insurance company. And don't hesitate to mention to the insurance people that you would have no problem taking the matter to the Office of Financial and Insurance Services: http://www.michigan.gov/cis/0,1607,7-154-10555_12902_35510_35696---,00.html#q2

Good Luck!Debbi

Thank you for the information Debbie.

If your insurance covers Dr. Orringer you should really check him out. His credentials are unbelievable. If you go to the Uof M surgeons website you can read all about him.

Thanks again.

[Guest guest]

Corri Natinsky wrote:

.... I have just found out that this surgeon is out of my

insurance network, wich means I have to pay 30% of the costs.

I can't help you with doctors in your area, but I have an insurance

suggestion. Often, you can get an out of network service covered as in

network, but you have to take steps to make it happen, and your doctors

will have to help you. Ask your insurance what the proceedure is. The

main thing is probably that your doctors need to show that in network

service may not be good enough. It may take some time and they may not

agree. There is a good chance they will though. I just went through

this, and I will know for sure when the bills are paid, but my

understanding at this time is that mine is covered as in network with

no other costs by me.

notan

[Guest guest]

Hi Debbie, Thanks for all the great information! I haven't had a consultation with him yet, I am awaiting the call with the appointment date and time. I will make sure to ask him a boatload of questions. He is the Head of Thoracic Surgery at Uof M. Since this condition is so rare, what is considered a good number? I also think that it isn't necessarily how many they have performed, but how many had complications after. Thanks again, amnd I will keep in touch! Corri in MIDebbi Heiser <imahockeymom@...> wrote: I don't recall that name from any achalasia research.... what kind of experience does

he have with this specific procedure -- the Heller Myotomy (how many does he perform each year)? Even though it's considerably closer than Cleveland, past personal experience has scared me off from UMMC for achalasia treatment. Dr. Nostrant (GI dept) lied to me about some things and misled me about some others, all of which left a very bad taste in my mouth (no pun intended). I have to trust the doctors cutting me open, and I have that trust in Dr. Rice that I don't think I could get from a colleague of Dr. Nostrant. On top of the trust issue is the experience issue -- Dr. Rice has done hundreds of Heller Myotomy procedures, and he has worked side by side with some of the most experienced achalasia doctors in the country. I hope you're able to get something sorted out with your insurance company. And don't hesitate to mention to the insurance people that you would have no problem taking the matter to the Office of Financial and Insurance Services: http://www.michigan.gov/cis/0,1607,7-154-10555_12902_35510_35696---,00.html#q2 Good Luck!Debbi Thank you for the

information Debbie. If your insurance covers Dr. Orringer you should really check him out. His credentials are unbelievable. If you go to the Uof M surgeons website you can read all about him. Thanks again.

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[Guest guest]

That is great Notan! I know my maximum out of pocket cost is $1500.00. I know I can live with that! Thanks again, and I hope you are doind great!notan ostrich <notan_ostrich@...> wrote: Corri Natinsky wrote: ... I have just found out that this surgeon is out of my insurance network, wich means I have to pay 30% of the costs.I can't help you with doctors in your area, but I have an insurance suggestion. Often, you can get an out of network service covered as in network, but you have to take steps to make it happen, and your doctors will have to help you. Ask your insurance what the proceedure is. The main thing is probably that your doctors need to show that in network service

may not be good enough. It may take some time and they may not agree. There is a good chance they will though. I just went through this, and I will know for sure when the bills are paid, but my understanding at this time is that mine is covered as in network with no other costs by me.notan

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[Guest guest]

Corri wrote:Since this condition is so rare, what is considered a good number?

Everyone's going to have a different opinion on this, but I wouldn't let anyone touch me if he's done less than 50 Heller Myotomies in the past 5-10 years. It's not just the total number performed that needs to be taken into account -- you want him to have RECENT experience as well.

Corri wrote:I also think that it isn't necessarily how many they have performed, but how many had complications after.

I wouldn't agree with that statement. This isn't a "cut and dried" (no pun intended) type of procedure. It's not like an appendectomy, where you just chop it off and sew it up. Every case is unique when it comes to the Heller. If you want to take complications into account, you'd also need to take into account the difficulty level of each individual surgery. Had the patient had Botox before? What about dilations? How many? How stretched-out is the body of the esophagus? How severe are the patient's symptoms? How much scar tissue was present? Had there been previous surgeries?

And you'd also need to define "complications" -- do you mean how many people had a perforation of the mucosa? Infections? How much of an improvement there was in swallowing function (again, keeping in mind that everyone's symptoms are different to begin with)? How long did the patient last before they had to seek another treatment?

I'd rather have surgery performed by someone who has done 100 myotomies with 5 instances of "complications" (however they may be defined) instead of someone who has done 20 myotomies with 0-1 complications, even though the first surgeon has so many more complications overall. Also, a surgeon who has done a lot of Hellers probably sees many more patients who are "worst case scenarios", so you would therefore expect him to have more complications. Again, that comes down to comparing the difficulty of each individual surgery.

There have been a lot of studies trying to determine the "best" way to do a Heller.... with or without a fundoplication, which type of fundoplications, laproscopic or open, etc., and so far the only thing that I've seen that indicates the probability of success is the experience level of the surgeon doing the surgery. I don't know how many achalasia patients your surgeon sees in a year's time, but I know back in the mid-90s it took Dr. Nostrant at UMMC a year to come up with 34 guinea pigs for his research study. I don't know how many they get every year now, but I know that TCC averages a couple hundred achalasia patients a year (not all have surgery), and Dr. Rice does a couple Hellers every week.

Thanks again, and I will keep in touch!

Let us know how it goes! Debbi

[Guest guest]

Debbie, thank you for the detailed emails. It has brought alot to light for me. I know Dr. Orringer is the Head of Thoracic surgery at UMMC and specializes in diseases of the Esophagus. I will learn a ton more when I meet for the consultation. My GI told me it would be 2 weeks before it was set up because they like to review the file and see if he wants any additional testing done. Thanks again, CorriDebbi Heiser <imahockeymom@...> wrote: Corri wrote:Since this condition is so rare, what is considered a good number? Everyone's going to have a different opinion on this, but I wouldn't let anyone touch me if he's done less than 50 Heller Myotomies in the past 5-10 years. It's not just the total number performed that needs to be taken into account -- you want him to have RECENT experience as well. Corri wrote:I also think that it isn't necessarily how many they have performed, but how many had complications after. I wouldn't agree with that statement. This isn't a "cut and dried" (no pun intended) type of procedure. It's not like an appendectomy, where you just

chop it off and sew it up. Every case is unique when it comes to the Heller. If you want to take complications into account, you'd also need to take into account the difficulty level of each individual surgery. Had the patient had Botox before? What about dilations? How many? How stretched-out is the body of the esophagus? How severe are the patient's symptoms? How much scar tissue was present? Had there been previous surgeries? And you'd also need to define "complications" -- do you mean how many people had a perforation of the mucosa? Infections? How much of an improvement there was in swallowing function (again, keeping in mind that everyone's symptoms are different to begin with)? How

long did the patient last before they had to seek another treatment? I'd rather have surgery performed by someone who has done 100 myotomies with 5 instances of "complications" (however they may be defined) instead of someone who has done 20 myotomies with 0-1 complications, even though the first surgeon has so many more complications overall. Also, a surgeon who has done a lot of Hellers probably sees many more patients who are "worst case scenarios", so you would therefore expect him to have more complications. Again, that comes down to comparing the difficulty of each individual surgery. There have been a lot of studies trying to determine the "best" way to

do a Heller.... with or without a fundoplication, which type of fundoplications, laproscopic or open, etc., and so far the only thing that I've seen that indicates the probability of success is the experience level of the surgeon doing the surgery. I don't know how many achalasia patients your surgeon sees in a year's time, but I know back in the mid-90s it took Dr. Nostrant at UMMC a year to come up with 34 guinea pigs for his research study. I don't know how many they get every year now, but I know that TCC averages a couple hundred achalasia patients a year (not all have surgery), and Dr. Rice does a couple Hellers every week. Thanks again, and I will keep in touch! Let us know how it goes!

Debbi

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[Guest guest]

Wow, only two weeks for an appt? That's a great timeframe.... it can be so hard to get in to see specialists in under 6-8 weeks!

Keep us posted, and read-read-read and ask-ask-ask -- there's a ton of info available here, and the more you know before your appt, the more you can actively participate in your treatment decisions. )Debbi

Debbie,

thank you for the detailed emails. It has brought alot to light for me.

I know Dr. Orringer is the Head of Thoracic surgery at UMMC and specializes in diseases of the Esophagus. I will learn a ton more when I meet for the consultation. My GI told me it would be 2 weeks before it was set up because they like to review the file and see if he wants any additional testing done.

Thanks again,

Corri

[Guest guest]

I feel so lucky with the sense of urgency that all my physicians have for me. I have done some extensive research on Dr. Orringer, and his credentials are ubelievable. I will definitely be going to my consultation with a list of questions.I will be his worst nightmare. Thank you again Debbie Corri in MIDebbi Heiser <imahockeymom@...> wrote: Wow, only two weeks for an appt? That's a great timeframe.... it can be so hard to get in to see specialists in under 6-8 weeks! Keep us posted, and read-read-read and ask-ask-ask -- there's a ton of info available here, and the more you know before your appt, the more you can actively participate in your treatment decisions. )Debbi Debbie, thank you for the detailed emails. It has brought alot to light for me. I know Dr. Orringer is the Head of Thoracic surgery at UMMC and specializes in diseases of the Esophagus. I will learn a ton more when I meet for the consultation. My GI told me it would be 2 weeks before it was set up because they like to review the file and see if he wants any additional testing done. Thanks again, Corri

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[Guest guest]

I would suggest to you that you speak with him directly and find out who he has been apprenticing. There are many who always assist in a surgery. A good surgeon always has an apprentice he favors and works with. Good Luck Carolyn ... mom to Cameron in CAp_geddes <pgeddes@...> wrote: How does one go about finding the right doctor/surgeon? We have been to Mayo Clinic in ville and understand Dr. Hinder is the best there. However, he is scheduled to

retire in a few months. Any suggestions? We live in Central Florida. Thanks. need ideas to promote your fundraiser or business? check out our new website! wicked cat promotional products www.wickedcatpromos.com

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[Guest guest]

I have never had the surgery, so I can't personally

recommend a surgeon to you.

We did have one member here who was operated on

by C. at Emory University. I looked at

his credentials once while he was there and looked

good. He recently moved to Mayo in ville.

Here is a link to him:

C. , M.D., new chair of Surgery, Mayo Clinic, ville, Fla.

If you go to pubmed.com and type in the search field

C, + achalasia you can find some

research papers he has written. The person he operated

on has not posted in a long time. That is usually a

good sign. Many leave the board once they have a

successful surgery. I might be able to find her email

address if yo would be interested in talking to her.

Again....I can't personally recommend him because I

have not used him myself.

If your finances and insurance permit travel, there

are several doctors that this board knows that have

done many myotomy's.

Ask your doctor how many surgeries he has done

for achalasia patients. See if he will give you

names to call. Don't be afraid to drill him

just as you would a contractor who was going

to build you a house.

Good Luck

Maggie AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com.

[Guest guest]

NO WAY, get a second or third opinion, I was messed up terribly there.

You can call and I can tell you 386-490-0865

>

> How does one go about finding the right doctor/surgeon? We have been

> to Mayo Clinic in ville and understand Dr. Hinder is

the

> best there. However, he is scheduled to retire in a few months. Any

> suggestions? We live in Central Florida. Thanks.

>

[Guest guest]

can you give me the name of the dr.at cedar senai

>

> If one has a PCP that one trusts, then that is the first place to

> start in terms of getting referrals.

>

> One can ask friends of course but frankly who really knows how valid

> the referrals of friends are -- most people have gotten

> recommendations for all kinds of horrible restaurants. If one knows

> the friend is a cautious careful consumer, then that is of course a

> possibility.

>

> My own quest for an OS began with my interest in having the anterior

> approach done. I was told that there was a doctor who did it at Cedar

> Sinai which is a world class hospital in Los Angeles -- and in fact is

> the hospital I wanted to have my surgery done at anyway -- both

> because of its reputation for excellence and because of its proximity

> to my home.

>

> I located the OS who was a Director of their orthopedic surgery

> department. I went on-line to check his education and background --

> all of this was first rate in terms of his undergrad, medical school

> and where he had done his residency. He had also trained extensively

> with Dr. Matta who is the " father " of the anterior approach in

> Los Angeles.

>

> In terms of any doctor, this is a start -- education, background and

> hospital affiliation because all are important factors and clues.

>

> I then made an appointment with the doctor. I was impressed with his

> demeanor and knowledge -- and by demeanor I don't mean a sales type of

> personality. I also asked him how many surgeries he had performed each

> year and how often he performed the surgeries. A doctor who operates

> frequently is going to be more proficient -- and one would want an OS

> who has performed the technique at least 100 times if one is dealing

> with one of the newer options like resurfacing or anterior approach.

>

> Important to me as well was that the doctor accepted my medical

> insurance. There were other doctors who didn't and I didn't even

> consider them -- I was perfectly confident putting my hip in the hands

> of the doctor I chose.

>

[Guest guest]

I was also an RN for many years, and at the start of my joint journey it was

easy as I used to scrub for the orthopaedic surgeon I chose.

However that was a while back and I don't like the way he now practices my

daughter who is also an RN hears the gossip and she was told he would have 3

people lined up in theatre and go from one to the other. NO thanks.he also had

done the wrong joint.

so I then had to find someone else. thats where it became hard because if you

research on the net they all say how good they are. etc etc,

so when it came for my shoulder to be re-done, I went on the recommendation of a

friend and I chose to travel 3 hours up the coast to Brisbane.

doing revisions is totally different from the first joint.

so in all this time my hip replacement goes belly up what is a girl to do,??

luckily when having the shoulders done, I did ask the girls in theatre who they

would go to and they were all unanimous, so I then asked the shoulder guy who to

see and he said the same.. so thats what I did and I haven't looked back it was

the best hip replacement I have ever had done, better than the 1st, 2nd, 3rd.

etc.