Guest guest Posted July 28, 2000 Report Share Posted July 28, 2000 In a message dated 7/28/00 1:26:23 PM Pacific Daylight Time, Dr_Rutledge@... writes: << > 2. Would you consider eliminating clinics for a few months. You > could stop accepting new insurance patients and only accept self pay. > You could weed out the less serious patients in the database and let > the serious ones proceed. > Any comments? RR >> How about clinics for those who are approved only? Regards, Debbie in IL Daughter MGB 8/9 Cigna (3rd appeal)--BMI 45 Counting on Cigna for Debbie (BMI 40) First request denied 7/21 :0( Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2000 Report Share Posted July 28, 2000 In a message dated 7/28/2000 4:41:19 PM Eastern Daylight Time, rhonda.cox@... writes: << Is there a big problem with getting the insurance to pay after they have approved and the surgery has been done? I know we probably sound like a bunch of whining, selfish people, but I hope you understand that emotions are running real high right now and I know I am having trouble processing this one. I do believe you care about all of us and I am sure this is not easy for you either. Thanks for giving us the chance to be heard. It tells me that I matter to you. Rhonda >> Rhonda, I think what Dr. R is saying is that his patient load is overwhelming. I don't it's so much to do with Insurance as trying to kinda slow things down a little so that he can give the kind of care that he feels this procedure warrants and he feels he can't do this if he's doing to much and flying through everyone trying to make sure everyone can get it done. Now on Debbie's end I'm sure the Insurance stuff has to be unbelievable and stressful, so I can see it from that point also. I wish I had some words of wisdom or a quick fix for Dr. R, his office and all of us, but alas I do not. I know the empty feeling you have is the same as mine wondering am I one who won't get to have the surgery, but let's not sink yet, with all the intelligent people we have on this site surely enough ideals will come up that something can be done to benefit everyone including Dr. R and his staff. I just wish I had the smarts to figure this one out. Cathy in Lenoir, NC 5' 0 " 216.5 Lbs. BMI 42 A journey of a thousand miles begins with a single step Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2000 Report Share Posted July 28, 2000 Hi, > > 1. Could patients take over the insurance aspect and deal with the > hassles themselves. Once your office received my denial, the ball > was in my court and I have had to run with it. What else could > patients do to help their own cause. Are the problems with insurance > after approval? > > 2. Would you consider eliminating clinics for a few months. You > could stop accepting new insurance patients and only accept self pay. > You could weed out the less serious patients in the database and let > the serious ones proceed. > Any comments? RR Rutledge, M.D., F.A.C.S. The Center for Laparoscopic Obesity Surgery 4301 Ben lin Blvd. Durham, N.C. 27704 Telephone #: Fax #: Email: DrR@... ************************************************ Please Visit our Web site: http://clos.net ************************************************ Durham Regional Hospital: Also, Please consider joining the Mini-Gastric Bypass Mailing List at http://www.onelist.com MiniGastricBypass is a general discussion of the Mini-Gastric Bypass ( http://www.onelist.com/community/MiniGastricBypass ) Talk with lots of other Pre and Post Op patients and friends. Keep up to date on the latest news about the Mini-Gastric Bypass. coming changes - > I know I already responded once regarding this topic. I had another > thought. I really want this surgery and would do anything necessary > to enable me to get it. I currently am doing everything humanly > possible to get approved. > > 1. Could patients take over the insurance aspect and deal with the > hassels themselves. Once your office received my denial, the ball > was in my court and I have had to run with it. What else could > patients do to help their own cause. Are the problems with insurance > after approval? > > 2. Would you consider eliminating clinics for a few months. You > could stop accepting new insurance patients and only accept self pay. > You could weed out the less serious patients in the database and let > the serious ones proceed. > > Thanks, Rozycki > > > > > This message is from the Mini-Gastric Bypass Mailing List at Onelist.com > Please visit our web site at http://clos.net > Get the Patient Manual at http://clos.net/get_patient_manual.htm > > To Unsubscribe Send and Email to: MiniGastricBypass-unsubscribe (AT) egroups (DOT) com > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2000 Report Share Posted July 28, 2000 1. Could patients take over the insurance aspect and deal with the > > hassles themselves. Once your office received my denial, the ball > > was in my court and I have had to run with it. What else could > > patients do to help their own cause. Are the problems with insurance > > after approval? Is there a big problem with getting the insurance to pay after they have approved and the surgery has been done? I know we probably sound like a bunch of whining, selfish people, but I hope you understand that emotions are running real high right now and I know I am having trouble processing this one. I do believe you care about all of us and I am sure this is not easy for you either. Thanks for giving us the chance to be heard. It tells me that I matter to you. Rhonda Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2000 Report Share Posted July 28, 2000 You could weed out the less serious patients in the database and let > the serious ones proceed.> Hi There is no fair way to " weed " out patients. Dr. R this is not easy! You have my prayers! I can understand you picking and choosing those who are in more medical need but everyone out there will think it is their self. Gee, Dr. R I 'd love to help, until the solution is put in place. Let me know, I can volunteer a few hours a week.........It breaks my heart to think someone like myself can not have the surgery because they dont have the cash on hand. I m so fortunate that all my ducks lined up for the MGB.. My life has drastically changed for the best and the weight loss is fanominale! I only wish this for all who are in need of the MGB to have the same opportunity that I had........ Thank-you From the bottom of my heart! Lori Honour 5-31-00 45 lbs gone In MiniGastricBypass (AT) egroups (DOT) com, " Rutledge, M.D., F.A.C.S. " <Dr_Rutledge@c...> wrote: > Hi, > > > > > 1. Could patients take over the insurance aspect and deal with the > > hassles themselves. Once your office received my denial, the ball > > was in my court and I have had to run with it. What else could > > patients do to help their own cause. Are the problems with insurance > > after approval? > > > > 2. Would you consider eliminating clinics for a few months. You > > could stop accepting new insurance patients and only accept self pay. > > You could weed out the less serious patients in the database and let > > the serious ones proceed. > > > > Any comments? > > RR > > Rutledge, M.D., F.A.C.S. > The Center for Laparoscopic Obesity Surgery > 4301 Ben lin Blvd. > Durham, N.C. 27704 > Telephone #: > Fax #: > Email: DrR@c... > > ************************************************ > Please Visit our Web site: http://clos.net > ************************************************ > > Durham Regional Hospital: > > Also, Please consider joining the > Mini-Gastric Bypass Mailing List > at http://www.onelist.com > > MiniGastricBypass is a general discussion of the Mini-Gastric Bypass > ( http://www.onelist.com/community/MiniGastricBypass ) > > Talk with lots of other Pre and Post Op > patients and friends. > Keep up to date on the latest news about > the Mini-Gastric Bypass. > coming changes - > > > > I know I already responded once regarding this topic. I had another > > thought. I really want this surgery and would do anything necessary > > to enable me to get it. I currently am doing everything humanly > > possible to get approved. > > > > 1. Could patients take over the insurance aspect and deal with the > > hassels themselves. Once your office received my denial, the ball > > was in my court and I have had to run with it. What else could > > patients do to help their own cause. Are the problems with insurance > > after approval? > > > > 2. Would you consider eliminating clinics for a few months. You > > could stop accepting new insurance patients and only accept self pay. > > You could weed out the less serious patients in the database and let > > the serious ones proceed. > > > > Thanks, Rozycki > > > > > > > > > > This message is from the Mini-Gastric Bypass Mailing List at Onelist.com > > Please visit our web site at http://clos.net > > Get the Patient Manual at http://clos.net/get_patient_manual.htm > > > > To Unsubscribe Send and Email to: > MiniGastricBypass-unsubscribe (AT) egroups (DOT) com > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2000 Report Share Posted July 28, 2000 DebLaMan@... wrote: > >> 2. Would you consider eliminating clinics for a few months. What would eliminating clinics accomplish? I'm not trying to be argumentative, I am just not following along on that part. I'm not sure what the objective is there? >> You could stop accepting new insurance patients and only accept self >> pay. I think your idea of accepting only self-pay patients is a good one. It would probably eliminate about 90% of the patient load and from the sounds of it, that is what needs to happen. However, while many people would be able to pay the $4000 surgery fee, that still leaves the hospital and anesthesia that have to be " pre-certified " by insurance (somebody has to do that . . .) or else patients will be paying about $14,000 themselves up front. I think there are probably plenty of people who can come up with $4,000, but $14,000? > You could weed out the less serious patients in the database and >let the serious ones proceed. By " serious, " do you mean the ones able and willing to pay (serious about getting the surgery), or the ones with more serious obesity? I think it would be a mistake for Dr. Rutledge to take the more serious obesity cases, such as revisions of RNY's, people over 350, people with a predisposition to have complications for one reason or another, because it is likely to skew the complication rate and safety statistics dramatically and it would not be a true reflection of the actual safety of the procedure for the average patient. Dr. Rutledge is a pioneer -- he is making history and setting the standards. For his procedure to become widely accepted -- and then be performed by many more surgeons, and benefit thousands and thousands more people -- he should not jeopardize the overall proof of the safety of the procedure by focusing on the riskiest patients. And yes, that would be sad news for the riskiest patients for the next few years, but in the long-term, thousands more people would benefit, as the procedure becomes widely accepted and performed. Additionally, while we are worried about allocating a scarce resource (Dr. Rutledge's surgical expertise) why should he spend 4 hours on one-patient, to reverse an RNY or fight scar tissue from a previous procedure, when he can do 7-8 normal MGB patients in that same time? In defense of this suggestion that he not accept high risk patients, it isn't like the high risk patients have no alternative in the meantime, either, because clearly they do (lap RNY and lap GBP w/duodenal switch are both available). It also isn't like the people with insurance have no alternative, either, since, again, insurance will cover the lap RNY (yes, I know it isn't as good, but when the alternative is that or *nothing,* it looks a little better). I'm trying to look at this from the big picture -- how to help the most people in the long run -- and I know that when you are the person wanting the surgery, it would be just heartbreaking to be one who is turned down. We all know how wonderful this surgery is. Just my two cents. Kind regards, > > Any comments? > > RR > >> > How about clinics for those who are approved only? > > Regards, > Debbie in IL > Daughter MGB 8/9 Cigna (3rd appeal)--BMI 45 > Counting on Cigna for Debbie (BMI 40) First request denied 7/21 :0( Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 28, 2000 Report Share Posted July 28, 2000 Seems that it is the denials that are time consuming. It seems the letter of information you send is very detailed if the insurance denies then it should be our responsibilty fight it or get legal councel if we have to. Just a thought If the insurance approves are you still have you had hassles from that? > Hi, > > > > > 1. Could patients take over the insurance aspect and deal with the > > hassles themselves. Once your office received my denial, the ball > > was in my court and I have had to run with it. What else could > > patients do to help their own cause. Are the problems with insurance > > after approval? > > > > 2. Would you consider eliminating clinics for a few months. You > > could stop accepting new insurance patients and only accept self pay. > > You could weed out the less serious patients in the database and let > > the serious ones proceed. > > > > Any comments? > > RR > > Rutledge, M.D., F.A.C.S. > The Center for Laparoscopic Obesity Surgery > 4301 Ben lin Blvd. > Durham, N.C. 27704 > Telephone #: > Fax #: > Email: DrR@c... > > ************************************************ > Please Visit our Web site: http://clos.net > ************************************************ > > Durham Regional Hospital: > > Also, Please consider joining the > Mini-Gastric Bypass Mailing List > at http://www.onelist.com > > MiniGastricBypass is a general discussion of the Mini-Gastric Bypass > ( http://www.onelist.com/community/MiniGastricBypass ) > > Talk with lots of other Pre and Post Op > patients and friends. > Keep up to date on the latest news about > the Mini-Gastric Bypass. > coming changes - > > > > I know I already responded once regarding this topic. I had another > > thought. I really want this surgery and would do anything necessary > > to enable me to get it. I currently am doing everything humanly > > possible to get approved. > > > > 1. Could patients take over the insurance aspect and deal with the > > hassels themselves. Once your office received my denial, the ball > > was in my court and I have had to run with it. What else could > > patients do to help their own cause. Are the problems with insurance > > after approval? > > > > 2. Would you consider eliminating clinics for a few months. You > > could stop accepting new insurance patients and only accept self pay. > > You could weed out the less serious patients in the database and let > > the serious ones proceed. > > > > Thanks, Rozycki > > > > > > > > > > This message is from the Mini-Gastric Bypass Mailing List at Onelist.com > > Please visit our web site at http://clos.net > > Get the Patient Manual at http://clos.net/get_patient_manual.htm > > > > To Unsubscribe Send and Email to: > MiniGastricBypass-unsubscribe (AT) egroups (DOT) com > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2000 Report Share Posted July 30, 2000 Dr. Rutledge, I'm pre-op so I haven't had the pleasure of meeting you but it seems you are a very caring surgeon or this would not be a hard decision for you to make. For this I thank you and look forwar to my surgery with much less apprehension! I handle all the insurance claims at a small family practice clinic and lots of times have to deal with what I feel like are " trumped up " excuses to delay payments. It is a pain in the neck and takes much patience and indurance. Is this the problem you are speaking of with the insurance companies? If so, this is my suggestion. If after the first attempt the insurance doesn't pay as expected, make a phone call to see if all was billed correctly. If they still refuse to pay on some technical reasons send out a bill and a form letter to the patient and let the patient try from their end. Phone calls from subscribers sometimes pull more weight from phone calls from the provider's office, especially if the subscriber has the insurance administrator at their office call their provider representative. It has helped a number of times at our office. I also think that all of your patients are so thankful to you and your practice that they would do all in their power to see that their insurance companies pay as they should, plus they do not want the bill to pay themselves if they have insurance that should pay. Just my 2 cents worth. ( Maybe 4 cents worth! lol) See you on the 15th! Dinah in Alabama > Hi, > > > > > 1. Could patients take over the insurance aspect and deal with the > > hassles themselves. Once your office received my denial, the ball > > was in my court and I have had to run with it. What else could > > patients do to help their own cause. Are the problems with insurance > > after approval? > > > > 2. Would you consider eliminating clinics for a few months. You > > could stop accepting new insurance patients and only accept self pay. > > You could weed out the less serious patients in the database and let > > the serious ones proceed. > > > > Any comments? > > RR > > Rutledge, M.D., F.A.C.S. > The Center for Laparoscopic Obesity Surgery > 4301 Ben lin Blvd. > Durham, N.C. 27704 > Telephone #: > Fax #: > Email: DrR@c... > > ************************************************ > Please Visit our Web site: http://clos.net > ************************************************ > > Durham Regional Hospital: > > Also, Please consider joining the > Mini-Gastric Bypass Mailing List > at http://www.onelist.com > > MiniGastricBypass is a general discussion of the Mini-Gastric Bypass > ( http://www.onelist.com/community/MiniGastricBypass ) > > Talk with lots of other Pre and Post Op > patients and friends. > Keep up to date on the latest news about > the Mini-Gastric Bypass. > coming changes - > > > > I know I already responded once regarding this topic. I had another > > thought. I really want this surgery and would do anything necessary > > to enable me to get it. I currently am doing everything humanly > > possible to get approved. > > > > 1. Could patients take over the insurance aspect and deal with the > > hassels themselves. Once your office received my denial, the ball > > was in my court and I have had to run with it. What else could > > patients do to help their own cause. Are the problems with insurance > > after approval? > > > > 2. Would you consider eliminating clinics for a few months. You > > could stop accepting new insurance patients and only accept self pay. > > You could weed out the less serious patients in the database and let > > the serious ones proceed. > > > > Thanks, Rozycki > > > > > > > > > > This message is from the Mini-Gastric Bypass Mailing List at Onelist.com > > Please visit our web site at http://clos.net > > Get the Patient Manual at http://clos.net/get_patient_manual.htm > > > > To Unsubscribe Send and Email to: > MiniGastricBypass-unsubscribe (AT) egroups (DOT) com > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2000 Report Share Posted July 31, 2000 > > > > >> 2. Would you consider eliminating clinics for a few months. > > What would eliminating clinics accomplish? I'm not trying to be > argumentative, I am just not following along on that part. I'm not sure > what the objective is there? By eliminating clinics for a time it would decrease new patient input. I learned of this procedure at a clinic and that is what hooked me and started me down the path of insurance denials. Clinics are very informative and very important, but if they were put on hold for a while Dr. R. could " whittle " down the patients. > > >> You could stop accepting new insurance patients and only accept self > >> pay. > > I think your idea of accepting only self-pay patients is a good one. It > would probably eliminate about 90% of the patient load and from the > sounds of it, that is what needs to happen. > > However, while many people would be able to pay the $4000 surgery fee, > that still leaves the hospital and anesthesia that have to be > " pre-certified " by insurance (somebody has to do that . . .) or else > patients will be paying about $14,000 themselves up front. I think > there are probably plenty of people who can come up with $4,000, but > $14,000? I suggest this also just as a temporary fix. Only new patients as of now, not those of us grandfathered, could be self pay. I know how important insurance coverage is. I will not be able to have this surgery unless I get my company to pay, or I switch plans in November and have it in January. > > > You could weed out the less serious patients in the database and > >let the serious ones proceed. > > By serious, I mean those who are actively seeking the surgery. Those who are working on packets, insurance approval or trying to find the money to be a self pay. There may be a few out there who aren't putting in a lot of effort right now, because they aren't sure they want to go this route. I did not mean anything medically. By " serious, " do you mean the ones able and willing to pay (serious > about getting the surgery), or the ones with more serious obesity? > > I think it would be a mistake for Dr. Rutledge to take the more serious > obesity cases, such as revisions of RNY's, people over 350, people with > a predisposition to have complications for one reason or another, > because it is likely to skew the complication rate and safety statistics > dramatically and it would not be a true reflection of the actual safety > of the procedure for the average patient. > > Dr. Rutledge is a pioneer -- he is making history and setting the > standards. For his procedure to become widely accepted -- and then be > performed by many more surgeons, and benefit thousands and thousands > more people -- he should not jeopardize the overall proof of the safety > of the procedure by focusing on the riskiest patients. And yes, that > would be sad news for the riskiest patients for the next few years, but > in the long-term, thousands more people would benefit, as the procedure > becomes widely accepted and performed. > > Additionally, while we are worried about allocating a scarce resource > (Dr. Rutledge's surgical expertise) why should he spend 4 hours on > one-patient, to reverse an RNY or fight scar tissue from a previous > procedure, when he can do 7-8 normal MGB patients in that same time? > > In defense of this suggestion that he not accept high risk patients, it > isn't like the high risk patients have no alternative in the meantime, > either, because clearly they do (lap RNY and lap GBP w/duodenal switch > are both available). > > It also isn't like the people with insurance have no alternative, > either, since, again, insurance will cover the lap RNY (yes, I know it > isn't as good, but when the alternative is that or *nothing,* it looks a > little better). > > I'm trying to look at this from the big picture -- how to help the most > people in the long run -- and I know that when you are the person > wanting the surgery, it would be just heartbreaking to be one who is > turned down. We all know how wonderful this surgery is. > > Just my two cents. > > Kind regards, > > > > > > > > Any comments? > > > > RR > > >> > > How about clinics for those who are approved only? > > > > Regards, > > Debbie in IL > > Daughter MGB 8/9 Cigna (3rd appeal)--BMI 45 > > Counting on Cigna for Debbie (BMI 40) First request denied 7/21 :0 ( Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2000 Report Share Posted July 31, 2000 In a message dated 7/31/00 7:12:52 AM Pacific Daylight Time, srozycki@... writes: << > > > > >> 2. Would you consider eliminating clinics for a few months. > > What would eliminating clinics accomplish? I'm not trying to be > argumentative, I am just not following along on that part. I'm not sure > what the objective is there? By eliminating clinics for a time it would decrease new patient input. I learned of this procedure at a clinic and that is what hooked me and started me down the path of insurance denials. Clinics are very informative and very important, but if they were put on hold for a while Dr. R. could " whittle " down the patients. >> This is funny--though the initial statement at the top appears to be mine, I really only replied to that post and what I said was, " How about clinics for those who are approved only? " I personally can't imagine the surgery without the clinic! Regards, Debbie in IL Daughter MGB 8/9 Cigna (3rd appeal)--BMI 45 Counting on Cigna for Debbie (BMI 40) First request denied 7/21 :0( Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2000 Report Share Posted July 31, 2000 > In a message dated 7/31/00 7:12:52 AM Pacific Daylight Time, > srozycki@... writes: > > By eliminating clinics for a time it would decrease new patient > input. I learned of this procedure at a clinic and that is what > hooked me and started me down the path of insurance denials. Clinics > are very informative and very important, but if they were put on hold > for a while Dr. R. could " whittle " down the patients. But Dr. R. uses them for patient education for patients who are having the surgery. It's required and very informative. He's still going to be doing 25-30 surgeries a week, so even if he just has clinics for the for-sure patients, that's a full day. That's why I didn't understand what you meant about cutting out clinics. I don't see it as a public information center kind of thing. Most of the people at the clinic I went to were all having surgery that week. Kind regards, Quote Link to comment Share on other sites More sharing options...
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