Re: SMELLY BILLING PRACTICES

[Guest guest]

I don't understand the global billing either, but I'm sure Dr R must have his

reason. It will certainly eliminate a lot of potential patients when preops

that have BC/BS or other insurance find out they won't get reimbursed pay

without a physician itemized invoice.

I got my letter of approval before I had the surgery. I took it to my bank

and got a $17,000 note that is now coming due for the 2nd time costing me a

total of $1000 in interest. I thought the approval meant that would pay for

the procedure. I didn't even consider their billing to be a problem. I don't

know anything medical billing.

Dr R is no doubt the best surgeon to get for this surgery, but we are not

getting any help with the billing problem.

Connie(Va)

[Guest guest]

i agree. i know it is a pain dealing with insurance companies, but

most doctors do it. since dr. rutledge has already made it so

difficult for patients by not accepting insurance, i cannot

understand why at least he cannot just give people an honest

accounting of the costs. i would not pay for *any* service that

refused to detail the expenses. and yes, i know, patients can choose

to go to another doctor--if i were a pre-op right now, that is what i

would do--but i happen to believe just because someone in a position

of power *can* be difficult doesn't mean it is the right thing to do.

anna

,

> <PRE>PLEASE, doesn't ANYBODY smell something not kosher here that

Dr. R. and his

> hospital REFUSE to give an itemized bill " I know we are all

desperate FAT

> PEOPLE but PLEASE doesn't ANYBODY feel they are being taken

advantage of,

> because we are so desperate. DR. R. is making how much money an

hour?? He

> could at least hire enough staff to avoid this terrible insurance

situations

> that are occuring. I know nobody wants to offend DR. R. because we

are so

> desperate, and we may not get our surgery if we offend, but THINK

about

> it.Appreciate any comments good or bad.

[Guest guest]

Dear ,

I would like to clarify some information for you. First off, the

reason why you do not get an itemized bill is because Dr. Rutledge has

reduced your rate of surgery by providing a global fee program. He has

gone to bat so to speak to get you and every other patient the lowest

price possible. He does not own stock in the hospital nor does he take

advantage in any way. Dr. Rutledge and staff are available 24/7 to all

our patients and there are not many doctors that can say that. I

apologize that you feel so upset, but to attack Dr. Rutledge and the

staff is very upsetting to me. If you would like to email me to get some

things off your chest, please feel free. Dr. Rutledge respects

everyone's opinion, and to play on other people's emotions to slander

someone is grossly inappropriate.

Newton

Medical Records

www.clos.net

www.shn@...

SMELLY BILLING PRACTICES

<PRE>PLEASE, doesn't ANYBODY smell something not kosher here that Dr. R.

and his

hospital REFUSE to give an itemized bill " I know we are all desperate

FAT

PEOPLE but PLEASE doesn't ANYBODY feel they are being taken advantage

of,

because we are so desperate. DR. R. is making how much money an hour??

He

could at least hire enough staff to avoid this terrible insurance

situations

that are occuring. I know nobody wants to offend DR. R. because we are

so

desperate, and we may not get our surgery if we offend, but THINK about

it.Appreciate any comments good or bad.

[Guest guest]

I had my mgb 2 yrs ago...blue cross blue shield paid 100% of the operation. Dr R

is at a stage in life where he has enough people willing to pay cash for the

operation and does not want or need the headache of dealing with insurance

carriers....can you blame him. I am sure if the people with cash started to

decrease he might reconsider dealing with insurance companies...this is

America...free and open market...it s his choice. Why should he complicate his

life more if his practice is thriving?

[Guest guest]

,

First, slow down alittle bit! Until you have been around and have done

the research to know that BC/BS sued Dr R stating he was fraudulent because

he was using the wrong CPT4 code for MGB surgery - of course -BC/BS of

Michigan doesn't have a code for MGB and no one at BC/BS can decide which

code should be used. Anyway - Dr R spent 1 million dollars fighting BC/BS

and then they dropped the suit. Think about the effect on you if they did

this to you and your profession. Secondly, - if you told your boss that you

could do a job in five hours and it would cost him $100 - then after you did

the job he said well we are only going to pay you $25.00 for the job - what

would you say and how long could you afford to work there? Well that is what

BC/BS has done - for example - the itmeized hospital bill for my MGB was

$24,000.00 (I only paid a total of $17,000.00 but the itemized bill per the

hospital is $24,000) however because of a PPO contract - BC/BS only

reimburses about $6,100.00 of the bill. Now come on - every business that I

know would be out of business - if they had to run a business like that!!!

It is not the MD's or nurses, etc making the big money - it is the insurance

companies!!!! The insurance situation is brought on by the insurance

companies - I worked in healthcare - community based - home health care for

20 years and have seen the terrible supposedly " cash savings " that these

insurance companies come up with!!! For example, my friend had RNY 6 months

before I had MGB - her bill totaled about $65,000 versus my MGB at $17,000

and they paid hers - no problem but they are fighting me to pay - heck - I

would be happy with $13,000 or $14,000 total. The problem is that insurance

companies need to put healthcare back in the hands of those who should be

handling healthcare - THE MD's and NURSES!!!!

Carol Hirn RN/BSN

Michigan

MGB:01/07/2002 - Dr R

268/175

SMELLY BILLING PRACTICES

> <PRE>PLEASE, doesn't ANYBODY smell something not kosher here that Dr. R.

and his

> hospital REFUSE to give an itemized bill " I know we are all desperate FAT

> PEOPLE but PLEASE doesn't ANYBODY feel they are being taken advantage of,

> because we are so desperate. DR. R. is making how much money an hour?? He

> could at least hire enough staff to avoid this terrible insurance

situations

> that are occuring. I know nobody wants to offend DR. R. because we are so

> desperate, and we may not get our surgery if we offend, but THINK about

> it.Appreciate any comments good or bad.

>

>

>

[Guest guest]

,

I have my opinions about the situation with the Global Bill myself.

However.... I assume you are post op since you are on this list. So you

knew going in that a Global Bill was to be issued. And you should have

known that this Global Bill would not be itemized. So to post here and

make innuendos that Dr Rutledge is making out like a fat rat and is

taking advantage of " desperate people " is grossly unfair. While he is

making a fair amount of money, he ALSO has to pay how many staff people?

He also has to pay the expenses of just running the physical office, and

equipment as well. How many doctors travel to outstate areas to meet

with patients? Or talk to surgeons interested in this new procedure?

Having worked in a dental office in the past I know that all of this

comes at the cost of a pretty penny.

My personal opinion, and this is not a reflection upon what I think of

Dr R or his staff, I think they are absolutely THE BEST bar none, but my

personal opinion is it would be nice as a courtesy if they provided an

itemized statement so that patients didn't have to fight with the

insurance companies. Notice I said nice? It's not required that he

give you any statement to satisfy insurance really. There is no

unwritten law that a doctor has to accept insurance.

While I know there have been instances that maybe Dr Rutledge hasn't

responded to phones calls or emails, I would bet ALL those that sound

the most urgent ARE answered within a reasonable time. The staff IS

available nearly at anytime you need them. For instance. Dr Rutledge

did not do my surgery. But he has agreed to take me on as a patient for

my post surgery needs. How many surgeons do you know would do that

without getting a fee or even an office call? I recently have had

concerns with h. pylori, again. He didn't answer my email, but I wrote

to Dana and SHE did answer. She called in a script for me. I thought

she hadn't. I phoned Penny and for what ever reason did not get a

reply, but when I voiced my concerns on this very list, I got a phone

call from Kathy within 24 hours, and emails from Dana. Turns out the

problem with the script was with MY pharmacy, not Dana. We exchanged

several emails and she called my script in Again. And talked with the

pharmacist. Know what? When she did all that she was home ill on a

Friday and she called in my script on a Saturday. How many Doctor's

staff have ever been that obliging too you? I doubt many have ever had

that luxury! I never have. Nearly every doctor's office I know of

would have had the opinion, " Sorry about your luck. " And not thought

twice about it.

It's just like risks of this surgery, a patient is a fool to ignore the

risks then be angry if now they have that complication.

Warmly,

LyndaV

Cushing Oklahoma USA

p8nlady@...

9/5/2001

296/168

...I am always happy to be a contact. But

Please....contact me privately.

> SMELLY BILLING PRACTICES

>

>

> <PRE>PLEASE, doesn't ANYBODY smell something not kosher here

> that Dr. R. and his

> hospital REFUSE to give an itemized bill " I know we are all

> desperate FAT

> PEOPLE but PLEASE doesn't ANYBODY feel they are being taken

> advantage of,

> because we are so desperate. DR. R. is making how much money

> an hour?? He

> could at least hire enough staff to avoid this terrible

> insurance situations

> that are occuring. I know nobody wants to offend DR. R.

> because we are so

> desperate, and we may not get our surgery if we offend, but

> THINK about

> it.Appreciate any comments good or bad.

>

>

[Guest guest]

I don't think there is anything illegal or fraudulent going on with Dr.

R's office - I just personally don't agree with the way he is conducting

business. I have been around and know how much things have cost him in

the past few years with lawyers, etc. I even sort of understand the

fact that he is taking only self-pay patients - it is something you see

with plastic surgeons, etc. However, if someone has insurance that for

example will pay 80% of any medical expenses to a physician why can't he

provide an itemized bill so they would get reimbursement. I am sure

that patient would not care that maybe the bill didn't total $17,000 -

maybe it was only $10,000 for example. If you can get 80% of $10,000 it

is better than getting 80% of nothing without the itemized bill!

As for the way the insurance company pays - I agreed that they do not

pay physicians and hospitals fairly. However, do I believe that a

surgeon's fee for a 45 minute procedure should be $3500 or more - not

really. I heard at my plastic surgeon's office yesterday that they had

billed the insurance company for a breast reconstruction on a cancer

patient. It took the physician the entire day and they billed $12,000

for the procedure. I believe my surgeon is very good, I understand that

he has a lot of overhead, etc. but $12,000? They were reimbursed only

$2000 for this procedure due to " reasonable and customary " . This is the

way our entire society is going - look at professional sports. They

make millions of dollars per year because their time that they can

participate actively in sports is limited - BAH HUMBUG! They can save

$$ like the rest of us. I do believe that physicians and surgeons

should be paid fairly for their services but I have to admit that I

think most charge too much......

and I think Dr. R should provide an itemized bill on request!

in GA

> SMELLY BILLING PRACTICES

>

>

> <PRE>PLEASE, doesn't ANYBODY smell something not kosher here

> that Dr. R. and his

> hospital REFUSE to give an itemized bill " I know we are all

> desperate FAT

> PEOPLE but PLEASE doesn't ANYBODY feel they are being taken

> advantage of,

> because we are so desperate. DR. R. is making how much money

> an hour?? He

> could at least hire enough staff to avoid this terrible

> insurance situations

> that are occuring. I know nobody wants to offend DR. R.

> because we are so

> desperate, and we may not get our surgery if we offend, but

> THINK about

> it.Appreciate any comments good or bad.

>

>

[Guest guest]

Thanks Fred

<A HREF= " www.loumilleragency.com " >LouAgency.com</A>

[Guest guest]

In response to the suggestion that Dr R's billing practices should be

questioned I would like you to read part of my interpretation of what is

going on. The issue in my opinion is all about the insurance industry's

inability to beat down a global fee with an out of network provider.

Even though traditional WLS bills in excess of $30,000 the insurance company

beats down the in network providers to grant discounts to the insurance

company. By the way those discounts are not available to the public if you

are privately paying.

Please note, in the following excerpt of my recent letter to my insurance

carrier, the fourth sentence which I believe centers on the true issue which

is an insurance industry

power play to have the insurance company keep control of MY care and not

allow ME to decide what is in my best interest.

Here is the relevant excerpt:

" In response to your letter of August 19, 2002, herewith find the invoice of

Dr. Rutledge. It is a global fee that includes hospital, drug, Doctor fee

(hospital and office pre and post op), and anesthesiologist fee. I

understand that global fees are not favored by the insurance industry. I

believe the reluctance to accept global fees has much to do with the

industry's inability to realize discounts as a result of insurance company

contractual agreements with in network providers. Dr. Rutledge has no

contracts with the insurance industry. I would ask however, that the

insurance industry's reluctance to accept global fees not negatively

influence your decision to reimburse me for the medically necessary

procedure I chose, which is reversible and significantly and demonstrably

far less risky to me than any of the alternate procedures.

There is precedent for global fees. I am advised that global fees have been

used and accepted in certain plastic surgery procedures as well as certain

liver transplants.

Dr. Rutledge buys bundled per capita services. In this way he brings to the

consumer a fixed fee that is far below the sum of the unbundled fees being

charged throughout the country for procedures designed to accomplish similar

outcomes. Please compare his bundled fee to the sum of fees for each of the

services required for other gastric surgery including a reasonable burden

for the cost of extended hospital stays and for the cost of complications

occurring in those procedures.

It is an unfortunate, that codes have not been created to accommodate the

successful procedure variation being laproscopically performed by a few

surgeons including Dr. Rutledge. The laparoscopic mini gastric bypass

permits many patients to avoid most of the very serious risks and

complications that are up to 4 or 5 times more common in the archaic

non-reversible procedure that has an acceptable and exact code that the

insurance industry would sanction.

Your continued assistance in my life saving pursuit would be appreciated. "

Perhaps my view can assist you in your pursuit of some fairness from your "

insurance company protector " .

Fred

8/2/02

362/318

SMELLY BILLING PRACTICES

> <PRE>PLEASE, doesn't ANYBODY smell something not kosher here that Dr. R.

and his

> hospital REFUSE to give an itemized bill " I know we are all desperate FAT

> PEOPLE but PLEASE doesn't ANYBODY feel they are being taken advantage of,

> because we are so desperate. DR. R. is making how much money an hour?? He

> could at least hire enough staff to avoid this terrible insurance

situations

> that are occuring. I know nobody wants to offend DR. R. because we are so

> desperate, and we may not get our surgery if we offend, but THINK about

> it.Appreciate any comments good or bad.

>

>

>

[Guest guest]

Well said ! I have been a nurse for 34 years and I've never had a

doctor give me his cell phone number to be reached 24/7. Not even my own

doctor would do that for me and I consider him a friend.

I feel very sorry for people who are having difficulty collecting from their

insurance companies, but being rude and verbally assaulting Dr. Rutledge is

not going to help. Try taking out your anger with your insurance company.

Dr. Rutledge saved my life and personally I think anyone's life is worth

every penny of that $17 grand!! Try looking on the fantastic and bright

side of it. Are you losing wt.? Are you healthier?

Blessings!

Betty

SMELLY BILLING PRACTICES

>

> <PRE>PLEASE, doesn't ANYBODY smell something not kosher here that Dr. R.

> and his

> hospital REFUSE to give an itemized bill " I know we are all desperate

> FAT

> PEOPLE but PLEASE doesn't ANYBODY feel they are being taken advantage

> of,

> because we are so desperate. DR. R. is making how much money an hour??

> He

> could at least hire enough staff to avoid this terrible insurance

> situations

> that are occuring. I know nobody wants to offend DR. R. because we are

> so

> desperate, and we may not get our surgery if we offend, but THINK about

> it.Appreciate any comments good or bad.

>

>

>

[Guest guest]

I agree that Dr Rutledge should not be criticized about billing. I work in a

hospital and do coding and trust me the insurance companies are legalized

crooks. There are procedures for which NO CODE exists. After dealing myself

with these people who are hired by the insurance companies to review claims and

make decisions I can tell you a lot of them don't have the foggiest idea of what

was done. There are hundreds of rules and regulations to be followed and most of

these people don't know what do if something falls out of the norm so they just

deny it.

Marge

[Guest guest]

Very Well Written Fred.. And thanks for coming this weekend to Chicago,

It was Great To see you and your lovely wife. Keep up the good work.

Penny Belcher

Patient Manager

704-871-0031(office)

704-682-1226(cell)

800-248-8961(fax)

pds@...

clos.net

Re: SMELLY BILLING PRACTICES

In response to the suggestion that Dr R's billing practices should be

questioned I would like you to read part of my interpretation of what is

going on. The issue in my opinion is all about the insurance industry's

inability to beat down a global fee with an out of network provider.

Even though traditional WLS bills in excess of $30,000 the insurance

company beats down the in network providers to grant discounts to the

insurance company. By the way those discounts are not available to the

public if you are privately paying.

Please note, in the following excerpt of my recent letter to my

insurance carrier, the fourth sentence which I believe centers on the

true issue which is an insurance industry power play to have the

insurance company keep control of MY care and not allow ME to decide

what is in my best interest.

Here is the relevant excerpt:

" In response to your letter of August 19, 2002, herewith find the

invoice of Dr. Rutledge. It is a global fee that includes hospital,

drug, Doctor fee (hospital and office pre and post op), and

anesthesiologist fee. I understand that global fees are not favored by

the insurance industry. I believe the reluctance to accept global fees

has much to do with the industry's inability to realize discounts as a

result of insurance company contractual agreements with in network

providers. Dr. Rutledge has no contracts with the insurance industry.

I would ask however, that the insurance industry's reluctance to accept

global fees not negatively influence your decision to reimburse me for

the medically necessary procedure I chose, which is reversible and

significantly and demonstrably far less risky to me than any of the

alternate procedures.

There is precedent for global fees. I am advised that global fees have

been used and accepted in certain plastic surgery procedures as well as

certain liver transplants.

Dr. Rutledge buys bundled per capita services. In this way he brings to

the consumer a fixed fee that is far below the sum of the unbundled fees

being charged throughout the country for procedures designed to

accomplish similar outcomes. Please compare his bundled fee to the sum

of fees for each of the services required for other gastric surgery

including a reasonable burden for the cost of extended hospital stays

and for the cost of complications occurring in those procedures.

It is an unfortunate, that codes have not been created to accommodate

the successful procedure variation being laproscopically performed by a

few surgeons including Dr. Rutledge. The laparoscopic mini gastric

bypass permits many patients to avoid most of the very serious risks and

complications that are up to 4 or 5 times more common in the archaic

non-reversible procedure that has an acceptable and exact code that the

insurance industry would sanction.

Your continued assistance in my life saving pursuit would be

appreciated. "

Perhaps my view can assist you in your pursuit of some fairness from

your " insurance company protector " .

Fred

8/2/02

362/318

SMELLY BILLING PRACTICES

> <PRE>PLEASE, doesn't ANYBODY smell something not kosher here that Dr.

> R.

and his

> hospital REFUSE to give an itemized bill " I know we are all desperate

> FAT PEOPLE but PLEASE doesn't ANYBODY feel they are being taken

> advantage of, because we are so desperate. DR. R. is making how much

> money an hour?? He could at least hire enough staff to avoid this

> terrible insurance

situations

> that are occuring. I know nobody wants to offend DR. R. because we are

> so desperate, and we may not get our surgery if we offend, but THINK

> about it.Appreciate any comments good or bad.

>

>

>

[Guest guest]

I couldn't agree more Betty. I think the lord each day for giving me

leading me to this surgery and Dr Rutledge. It has saved my life and my

life is worth alot more to me than 17,000. I'm sure the majority of us

agree with that. We need to count our blessings and move on.

Penny Belcher

Patient Manager

704-871-0031(office)

704-682-1226(cell)

800-248-8961(fax)

pds@...

clos.net

Re: SMELLY BILLING PRACTICES

Well said ! I have been a nurse for 34 years and I've never had

a doctor give me his cell phone number to be reached 24/7. Not even my

own doctor would do that for me and I consider him a friend.

I feel very sorry for people who are having difficulty collecting from

their insurance companies, but being rude and verbally assaulting Dr.

Rutledge is not going to help. Try taking out your anger with your

insurance company. Dr. Rutledge saved my life and personally I think

anyone's life is worth every penny of that $17 grand!! Try looking on

the fantastic and bright side of it. Are you losing wt.? Are you

healthier?

Blessings!

Betty

SMELLY BILLING PRACTICES

>

> <PRE>PLEASE, doesn't ANYBODY smell something not kosher here that Dr.

> R. and his hospital REFUSE to give an itemized bill " I know we are all

> desperate FAT

> PEOPLE but PLEASE doesn't ANYBODY feel they are being taken advantage

> of,

> because we are so desperate. DR. R. is making how much money an hour??

> He

> could at least hire enough staff to avoid this terrible insurance

> situations

> that are occuring. I know nobody wants to offend DR. R. because we are

> so

> desperate, and we may not get our surgery if we offend, but THINK

about

> it.Appreciate any comments good or bad.

>

>

>

[Guest guest]

OHHHHH Fred!!! Boy can I hire you to help me fight BC/BS of Michigan???? I

LOVE your letter!!! I agree with you 100% - lets blame the real culprits in

this situation! The insurance companies!!!

Carol H

Michi

MGB: 01/07/2002 - Dr R

268/175

SMELLY BILLING PRACTICES

>

>

> > <PRE>PLEASE, doesn't ANYBODY smell something not kosher here that Dr. R.

> and his

> > hospital REFUSE to give an itemized bill " I know we are all desperate

FAT

> > PEOPLE but PLEASE doesn't ANYBODY feel they are being taken advantage

of,

> > because we are so desperate. DR. R. is making how much money an hour??

He

> > could at least hire enough staff to avoid this terrible insurance

> situations

> > that are occuring. I know nobody wants to offend DR. R. because we are

so

> > desperate, and we may not get our surgery if we offend, but THINK about

> > it.Appreciate any comments good or bad.

> >

> >

> >

[Guest guest]

I'm not sure where to even begin with this.

First LnJ...no one has the right to get down on you or anyone else.

You're expressing an opinion but there is a fine line when you start what is

perceived as an attack against Dr rutledge and/or his staff.

AS many other responses have address some of the points I would have made

but I'll make these additional ones:

1. Not taking insurance has nothing to do with hiring staff. At the same

time Dr Rutledge discontinued accepting insurance, I had 3 other doctors

(not related..gyn,internist, asmetha) make the very same decision. In my

company we have a whole business practice that deals with Healthcare and

this exiting away from taking insurance is becoming bigger and bigger all

across the United States in every type of practice. There are many reasons

for this, insurance companies are NOT prompt in paying (doctors can't afford

to wait months, they're running a business), they undercut what the doctor

gets paid (normal visit that's billed at $80 the doctors get paid $26...how

would we like our paychecks to get such reductions), they tell the doctor

what he can or cannot order as far as tests and procedures (taking

healthcare away fromthe doctors and nurses into the hands of who knows,

what!), etc... (the list goes on and on)

2. When dealing with prepayment, it's the patients responsbility to inform

the insurance company at time of pre-authorization (or pre-determination of

benefits) that the doctor requires a prepayment and that he/she is providing

a global fee for services and therefore the bill will not be detailed. Any

insrurance company who pays for bypasses should consider themselves lucky to

be paying only $17000 whent he average cost is $60000.

3. From an accounting viewpoint (this is my professional and has been for

30 years), it's difficult to distribute the cost on a per item basis. Not

that discounts can't be applied because we see it everyday in the retail

store but the problem comes into whether the insurance company will still

accept the dollar distribution and costs stated in the bill. Oh here comes

the insurance company again.

4. You stated that we are " desperate FAT PEOPLE " . If you acted out of

desperation to have the mgb then your pysch review did NOT evulate you well

at all! Desperate people DON'T make well informed decisions, they react

quickly and irrational. There is no way if you went through the process to

get Doctor Rutledge to perform the surgery with all his pre-operative packet

and education could you even consider yourself, let alone me as being

desperate.

5. AS far as Dr Rutledge being a wealthy man and having stock in the

hospital. From what I was told my other mgb patients who had insurance that

paid (in the days Dr R was taking insurance) do you know what the average

payment to DR R was? $1200. Yes that's all! $1200 out of a bill of $17000.

You don't get rich being paid $1200 for surgery, pay your staff, office

bills, insurance permiums, etc on that. Additionally, $10000 went to the

hospital itself. Now the fact that Dr Rutledge is only is charging the same

$17000 two years later, he should be congradulated for keeping the costs

down.

There again LnJ, don't take this as an attack on you. Please consider

all the facts before implying something. The fact that your email made it

on the post op site, means that it made it through Dr R's office and they

were willing for you to post you opinions. I respect them for allowing it

to be posted (since as owner's of the website mail group they could have

blocked it) and I RESPECT you for stating your opinion. I'm sorry you're

having such problems.

Moira

2/28/01 360 203 Dr R

>From: LnJ@...

>Reply-

>

>Subject: SMELLY BILLING PRACTICES

>Date: Wed, 2 Oct 2002 13:22:09 EDT

>

><PRE>PLEASE, doesn't ANYBODY smell something not kosher here that Dr. R.

>and his

>hospital REFUSE to give an itemized bill " I know we are all desperate FAT

>PEOPLE but PLEASE doesn't ANYBODY feel they are being taken advantage of,

>because we are so desperate. DR. R. is making how much money an hour?? He

>could at least hire enough staff to avoid this terrible insurance

>situations

>that are occuring. I know nobody wants to offend DR. R. because we are so

>desperate, and we may not get our surgery if we offend, but THINK about

>it.Appreciate any comments good or bad.

_________________________________________________________________

Join the world’s largest e-mail service with MSN Hotmail.

http://www.hotmail.com

[Guest guest]

, I agree completely with your comments. Audry

>>> jwmson1@... 10/02/02 03:20PM >>>

I don't think there is anything illegal or fraudulent going on with

Dr.

R's office - I just personally don't agree with the way he is

conducting

business. I have been around and know how much things have cost him

in

the past few years with lawyers, etc. I even sort of understand the

fact that he is taking only self-pay patients - it is something you

see

with plastic surgeons, etc. However, if someone has insurance that

for

example will pay 80% of any medical expenses to a physician why can't

he

provide an itemized bill so they would get reimbursement. I am sure

that patient would not care that maybe the bill didn't total $17,000 -

maybe it was only $10,000 for example. If you can get 80% of $10,000

it

is better than getting 80% of nothing without the itemized bill!

As for the way the insurance company pays - I agreed that they do not

pay physicians and hospitals fairly. However, do I believe that a

surgeon's fee for a 45 minute procedure should be $3500 or more - not

really. I heard at my plastic surgeon's office yesterday that they

had

billed the insurance company for a breast reconstruction on a cancer

patient. It took the physician the entire day and they billed $12,000

for the procedure. I believe my surgeon is very good, I understand

that

he has a lot of overhead, etc. but $12,000? They were reimbursed

only

$2000 for this procedure due to " reasonable and customary " . This is

the

way our entire society is going - look at professional sports. They

make millions of dollars per year because their time that they can

participate actively in sports is limited - BAH HUMBUG! They can save

$$ like the rest of us. I do believe that physicians and surgeons

should be paid fairly for their services but I have to admit that I

think most charge too much......

and I think Dr. R should provide an itemized bill on request!

in GA

> SMELLY BILLING PRACTICES

>

>

> <PRE>PLEASE, doesn't ANYBODY smell something not kosher here

> that Dr. R. and his

> hospital REFUSE to give an itemized bill " I know we are all

> desperate FAT

> PEOPLE but PLEASE doesn't ANYBODY feel they are being taken

> advantage of,

> because we are so desperate. DR. R. is making how much money

> an hour?? He

> could at least hire enough staff to avoid this terrible

> insurance situations

> that are occuring. I know nobody wants to offend DR. R.

> because we are so

> desperate, and we may not get our surgery if we offend, but

> THINK about

> it.Appreciate any comments good or bad.

>

>

[Guest guest]

Hi,

First let me say that $17,000. seems like a lot of money, and if you did a

break down of and open surgery it would be. For a lap surgery RR uses all

top of the line disposables which are very costly. He has one of the largest

staffs of any WLS program, his staff is equipped with the state of the art

equipment to have your information with them at all times, in case you need

help.

If you have a complication YOU are not charged extra we eat that bill which

is very costly.

Why do we use a global bill? First we contract with hospitals, doctors etc.

for a flat fee. So look at it like we lease the OR, If you were to get an

itemized bill it would far exceed $17,000!

Why do we not take insurance (for now)?

1. Just as some of you have experienced insurance companies pre-approve you

but might never pay.

2. Hospitals lose thousands on WLS (insurance reimbursement).

3.WLS are frowned on by some hospitals because of the liability involved

with it, so most would rather have a drug program.

4. To be a WLS surgeon the insurance is enormous.

The reasons are endless.

Check out a bill from another program and compare it and if you have a

complication and are a cash pay you go into shock of the cost.

Our hospitals give the best service to our patients because they know they

are getting paid NOW! They want you there, they want to make you happy and

give quality care that we can be proud of. It is sad but true.

When I had my surgery, I had a temp nurse that knew nothing about WLS, I

saw her once in the night, I had a blood soaked gown, she added (not

removed) more gauze and tape. The next nurse I saw was for discharge and he

wouldn't let me leave until I had eaten something (broth) Well, no one ever

brought me anything the entire night.

My husband passed out ice chips to my littermates and checked in on them

because he was concerned that the staff could care less about the obese

patients.

Our hospitals now, are constantly checking on you, they make sure you are

not in pain, they make sure you have what ever you need, they check your

vitals, they stay in constant contact with RR or Dana.

If you are not up to par they don't make us wait for insurance approval to

go back in and explore you.

They don't complain that they had to change your gown if it was soiled. And

most important they allow our staff to give constant in-service to educate

their staff on how to care for our patients.

WLS is still considered an elective surgery by most,

It is a constant battle for acceptance. So to get quality care we pay out a

lot. Insurance companies are still living in the dark ages, instead of

preventative measures they allow people to become very ill before they dish

out the funds. Your premiums are higher if your obese or have an illness.

To me, they should look past their prejudice views and say wow 17,000. is

worth having healthy customers, instead they will pay thousands more for you

to end up in an emergency room or be dependant on medications or even die.

Sorry, I would like to say more but I have to get back to work.

Peace,

Trish

Re: SMELLY BILLING PRACTICES

> I don't understand the global billing either, but I'm sure Dr R must have

his

> reason. It will certainly eliminate a lot of potential patients when

preops

> that have BC/BS or other insurance find out they won't get reimbursed pay

> without a physician itemized invoice.

>

> I got my letter of approval before I had the surgery. I took it to my bank

> and got a $17,000 note that is now coming due for the 2nd time costing me

a

> total of $1000 in interest. I thought the approval meant that would pay

for

> the procedure. I didn't even consider their billing to be a problem. I

don't

> know anything medical billing.

>

> Dr R is no doubt the best surgeon to get for this surgery, but we are not

> getting any help with the billing problem.

>

> Connie(Va)

>

>

>

[Guest guest]

Apparently global billing is becoming the way of the world - at least

with some types of surgeries. I suspect " normal " obstetric care for

example is already going that way too - including the delivery and

everything in one price. I don't think most of us are questioning

the ethics involved, etc. I also have no doubt that all of the

current patients are getting excellent treatment both from Dr. R and

his staff - better treatment actually than those of us who went

before due to the fact that the office is more specifically dedicated

to Dr. R's patients and needs.

I think the question still comes into play though as to why can't an

itemized bill be presented from the hospital. Knowing the way

hospitals work the bill does exist. Everything in a hospital has a

billing tag and it is all charged back to the patient account

number. Even if this bill does exceed the $17,000 - or even if it is

much less - who cares! If the patient managed to secure a promise of

reimbursement all on their own why can't an itemized bill be

furnished from the hospital and even a flat rate surgical bill if

needed. As we all know unfortunately the insurance companies are

going to pay " usual and customary " regardless of what is billed so it

in some ways doesn't even matter what the amount is - unless of

course you are the patient that can't get reimbursed what is OWED to

them by the insurance company because of lack of having an itemized

bill.

Your explanation of things though Trish was great - I just really

feel for those trying to get reimbursement.

in GA

> Hi,

>

> First let me say that $17,000. seems like a lot of money, and if

you did a

> break down of and open surgery it would be. For a lap surgery RR

uses all

> top of the line disposables which are very costly. He has one of

the largest

> staffs of any WLS program, his staff is equipped with the state of

the art

> equipment to have your information with them at all times, in case

you need

> help.

> If you have a complication YOU are not charged extra we eat that

bill which

> is very costly.

> Why do we use a global bill? First we contract with hospitals,

doctors etc.

> for a flat fee. So look at it like we lease the OR, If you were to

get an

> itemized bill it would far exceed $17,000!

> Why do we not take insurance (for now)?

> 1. Just as some of you have experienced insurance companies pre-

approve you

> but might never pay.

> 2. Hospitals lose thousands on WLS (insurance reimbursement).

> 3.WLS are frowned on by some hospitals because of the liability

involved

> with it, so most would rather have a drug program.

> 4. To be a WLS surgeon the insurance is enormous.

>

> The reasons are endless.

>

> Check out a bill from another program and compare it and if you

have a

> complication and are a cash pay you go into shock of the cost.

>

> Our hospitals give the best service to our patients because they

know they

> are getting paid NOW! They want you there, they want to make you

happy and

> give quality care that we can be proud of. It is sad but true.

> When I had my surgery, I had a temp nurse that knew nothing about

WLS, I

> saw her once in the night, I had a blood soaked gown, she added (not

> removed) more gauze and tape. The next nurse I saw was for

discharge and he

> wouldn't let me leave until I had eaten something (broth) Well, no

one ever

> brought me anything the entire night.

> My husband passed out ice chips to my littermates and checked in on

them

> because he was concerned that the staff could care less about the

obese

> patients.

> Our hospitals now, are constantly checking on you, they make sure

you are

> not in pain, they make sure you have what ever you need, they check

your

> vitals, they stay in constant contact with RR or Dana.

> If you are not up to par they don't make us wait for insurance

approval to

> go back in and explore you.

> They don't complain that they had to change your gown if it was

soiled. And

> most important they allow our staff to give constant in-service to

educate

> their staff on how to care for our patients.

> WLS is still considered an elective surgery by most,

> It is a constant battle for acceptance. So to get quality care we

pay out a

> lot. Insurance companies are still living in the dark ages,

instead of

> preventative measures they allow people to become very ill before

they dish

> out the funds. Your premiums are higher if your obese or have an

illness.

> To me, they should look past their prejudice views and say wow

17,000. is

> worth having healthy customers, instead they will pay thousands

more for you

> to end up in an emergency room or be dependant on medications or

even die.

> Sorry, I would like to say more but I have to get back to work.

> Peace,

>

> Trish

>

> Re: SMELLY BILLING PRACTICES

>

>

> > I don't understand the global billing either, but I'm sure Dr R

must have

> his

> > reason. It will certainly eliminate a lot of potential patients

when

> preops

> > that have BC/BS or other insurance find out they won't get

reimbursed pay

> > without a physician itemized invoice.

> >

> > I got my letter of approval before I had the surgery. I took it

to my bank

> > and got a $17,000 note that is now coming due for the 2nd time

costing me

> a

> > total of $1000 in interest. I thought the approval meant that

would pay

> for

> > the procedure. I didn't even consider their billing to be a

problem. I

> don't

> > know anything medical billing.

> >

> > Dr R is no doubt the best surgeon to get for this surgery, but we

are not

> > getting any help with the billing problem.

> >

> > Connie(Va)

> >

> >

> >

[Guest guest]

Yea, you are awesome!

LyndaV

> Re: SMELLY BILLING PRACTICES

>

>

> Apparently global billing is becoming the way of the world - at least

> with some types of surgeries. I suspect " normal " obstetric care for

> example is already going that way too - including the delivery and

> everything in one price. I don't think most of us are questioning

> the ethics involved, etc. I also have no doubt that all of the

> current patients are getting excellent treatment both from Dr. R and

> his staff - better treatment actually than those of us who went

> before due to the fact that the office is more specifically dedicated

> to Dr. R's patients and needs.

>

> I think the question still comes into play though as to why can't an

> itemized bill be presented from the hospital. Knowing the way

> hospitals work the bill does exist. Everything in a hospital has a

> billing tag and it is all charged back to the patient account

> number. Even if this bill does exceed the $17,000 - or even if it is

> much less - who cares! If the patient managed to secure a promise of

> reimbursement all on their own why can't an itemized bill be

> furnished from the hospital and even a flat rate surgical bill if

> needed. As we all know unfortunately the insurance companies are

> going to pay " usual and customary " regardless of what is billed so it

> in some ways doesn't even matter what the amount is - unless of

> course you are the patient that can't get reimbursed what is OWED to

> them by the insurance company because of lack of having an itemized

> bill.

>

> Your explanation of things though Trish was great - I just really

> feel for those trying to get reimbursement.

>

> in GA

>

>

>

> > Hi,

> >

> > First let me say that $17,000. seems like a lot of money, and if

> you did a

> > break down of and open surgery it would be. For a lap surgery RR

> uses all

> > top of the line disposables which are very costly. He has one of

> the largest

> > staffs of any WLS program, his staff is equipped with the state of

> the art

> > equipment to have your information with them at all times, in case

> you need

> > help.

> > If you have a complication YOU are not charged extra we eat that

> bill which

> > is very costly.

> > Why do we use a global bill? First we contract with hospitals,

> doctors etc.

> > for a flat fee. So look at it like we lease the OR, If you were to

> get an

> > itemized bill it would far exceed $17,000!

> > Why do we not take insurance (for now)?

> > 1. Just as some of you have experienced insurance companies pre-

> approve you

> > but might never pay.

> > 2. Hospitals lose thousands on WLS (insurance reimbursement). 3.WLS

> > are frowned on by some hospitals because of the liability

> involved

> > with it, so most would rather have a drug program.

> > 4. To be a WLS surgeon the insurance is enormous.

> >

> > The reasons are endless.

> >

> > Check out a bill from another program and compare it and if you

> have a

> > complication and are a cash pay you go into shock of the cost.

> >

> > Our hospitals give the best service to our patients because they

> know they

> > are getting paid NOW! They want you there, they want to make you

> happy and

> > give quality care that we can be proud of. It is sad but

> true. When I

> > had my surgery, I had a temp nurse that knew nothing about

> WLS, I

> > saw her once in the night, I had a blood soaked gown, she added (not

> > removed) more gauze and tape. The next nurse I saw was for

> discharge and he

> > wouldn't let me leave until I had eaten something (broth) Well, no

> one ever

> > brought me anything the entire night.

> > My husband passed out ice chips to my littermates and checked in on

> them

> > because he was concerned that the staff could care less about the

> obese

> > patients.

> > Our hospitals now, are constantly checking on you, they make sure

> you are

> > not in pain, they make sure you have what ever you need, they check

> your

> > vitals, they stay in constant contact with RR or Dana.

> > If you are not up to par they don't make us wait for insurance

> approval to

> > go back in and explore you.

> > They don't complain that they had to change your gown if it was

> soiled. And

> > most important they allow our staff to give constant in-service to

> educate

> > their staff on how to care for our patients.

> > WLS is still considered an elective surgery by most,

> > It is a constant battle for acceptance. So to get quality care we

> pay out a

> > lot. Insurance companies are still living in the dark ages,

> instead of

> > preventative measures they allow people to become very ill before

> they dish

> > out the funds. Your premiums are higher if your obese or have an

> illness.

> > To me, they should look past their prejudice views and say wow

> 17,000. is

> > worth having healthy customers, instead they will pay thousands

> more for you

> > to end up in an emergency room or be dependant on medications or

> even die.

> > Sorry, I would like to say more but I have to get back to

> work. Peace,

> >

> > Trish

> >

> > Re: SMELLY BILLING PRACTICES

> >

> >

> > > I don't understand the global billing either, but I'm sure Dr R

> must have

> > his

> > > reason. It will certainly eliminate a lot of potential patients

> when

> > preops

> > > that have BC/BS or other insurance find out they won't get

> reimbursed pay

> > > without a physician itemized invoice.

> > >

> > > I got my letter of approval before I had the surgery. I took it

> to my bank

> > > and got a $17,000 note that is now coming due for the 2nd time

> costing me

> > a

> > > total of $1000 in interest. I thought the approval meant that

> would pay

> > for

> > > the procedure. I didn't even consider their billing to be a

> problem. I

> > don't

> > > know anything medical billing.

> > >

> > > Dr R is no doubt the best surgeon to get for this surgery, but we

> are not

> > > getting any help with the billing problem.

> > >

> > > Connie(Va)

> > >

> > >

> > >

[Guest guest]

<PRE>You said just how I feel. But you have some people who just do not get it

and

consider any negative comments about Dr. R. or his billing practices as being

mean spirited.

[Guest guest]

<PRE>SO IT IS ALL ABOUT MONEY, NOT SAVING LIVES> THANK YOU FOR SETTING THE

RTECORD

STRAIGHT.

[Guest guest]

<PRE>Thank You for not being nasty or threatning as some have been. Paying up

front is okey with me, but if you need an itemized bill to get reimbursed it

should be avaliable even if you have to pay a few dollars extra for the time

to make it up. His staff should be able to do this without cutting into Dr.

R.'s time.

[Guest guest]

In a message dated 10/4/02 9:48:09 AM Eastern Daylight Time, LnJ@...

writes:

> SO IT IS ALL ABOUT MONEY, NOT SAVING LIVES> THANK YOU FOR SETTING THE

> RTECORD

> STRAIGHT

Why do you go to work??? How do you pay your bills if its just to improve the

world?? THis is America is there anything wrong with having both as

objectives??

Just curious,

BUsching

[Guest guest]

Hi ,

Are you thinking of getting a revision??? The last time I saw you you

looked terrific. I know you are 2+ years out like me, are you starting

to regain?? How's ? Is she regaining too?? My suggestion is NOT to

be revised to a RNY. I am going to have my RNY revision turned back

into another MGB or as close as possible after the first of the year.

Dr.R is wanting the scars to cool down first. I'm up to 187 from a low

of 172. The RNY really sucks. I loved my MGB. The only good thing

about the RNY is the gas isn't as deadly.LOL

Hope you find what you're searching for. Give a hug for me.

Love,

Genz

> <PRE>Thank You for not being nasty or threatning as some have been.

Paying up

> front is okey with me, but if you need an itemized bill to get

reimbursed it

> should be avaliable even if you have to pay a few dollars extra for

the time

> to make it up. His staff should be able to do this without cutting

into Dr.

> R.'s time.

[Guest guest]

I think the whole insurance issue is clearly stated where Dr. R stands. He's

open and upfront. We make the choice to work with the insurance ourselves or

not... From the frustrations aired it is clear why Dr. R would be frustrated

even without the past history of fighting for his money due....

If I have understood him correctly, because my insurance kicked about the

global billing as well, but I was told that he would be in breach of contract

with the hospital if the fees were broken out. I had to submit a letter from

Dr. R stating this fact and this was accepted and eventually they paid. I

know that's not fair of me to defend since I was reimbursed, but I knew going

in there was a chance I may not get the money back. I had the prior

approval, but no money in hand. Like many things this was a choice.

This type of billing is used in other situations such as maternity. I know

there are those individuals that have had extra care and extended stays free

of any additional costs and that's not typical either.

I don't mean to make digs, but it seems that everyone thinks he's making this

rule up. A contract/agreement is in place if I understood him correctly. I

was leary of the set up, but I trusted him enough to perform this surgery and

felt that it was right for me.

Kim