Coming Changes

July 28, 2000

Dr. Rutledge:

Seeing as you are looking for a " date " for cut off so to speak, and

depending upon how quickly you want this " cut-off " , would August 15 or

31 or even September 1, 2000 be an option..... I realize that you are

not talking about " grandfathered " or " grandmothered " patients, but that

is to say, as far as you accepting new patients for future surgery.

Also, what about eliminating the " patient form " or other criteria from

the web site? Might this slow some of the patient influx?

Just a thought!

Joannie

Irving, Tx.

July 28, 2000

Thank you, Dr. Rutledge.

I feel a lot better now.

Brown

Vancouver, WA

-Patient info sent June 2

-Completed Application packet sent July 27th

-ODS Health Plan Denied, " Insufficient documentation of co-morbidities. "

-Appeal packet, with strong documentation, faxed and sent to ODS today.

-Crossing fingers, toes, and even eyes.... patiently (ok, trying to be, at

least! LOL) waiting to cross.

__________________________________________________________________

Message: 5

Date: Fri, 28 Jul 2000 16:23:00 -0400

Subject: Re: Coming Changes

Hi,

For patients that are already in progress we will continue to proceed as in

the past.

I have to do something and I am asking for advice and suggestions.

I simply cannot manage all of the patients that want to have the surgery and

the insurance battles are wearing me down.

Suggestions wanted.

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@...

________________________________________________________________________

Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com

July 28, 2000

I'm not sure what to think. I have been lurking for a couple of weeks now

and have taken steps to seriously investigate MGB as an alternative for me.

I have talked to my therapist who didn't see any red flags, I have an

appointment with my PCP on August 2 to discuss it with her, and I'm going to

visit my parents the weekend of August 12th and had planned to discuss the

idea with them. Get their support. The few friends who I have discussed it

with have been very supportive. In fact one of them offered to come with me

to NC from Atlanta if/when I go through the surgery. I'm going to hang in

there...

I do like the idea of an enrollment period and putting wannabes on a waiting

list.

Dr. Rutledge, if you get more applicants than you can handle, how about first

applying your screening criteria and then selecting patients through a

lottery (random number selector -- based on the number of slots you can

realistically operate on and you and your staff can support). That way you

don't have to make the decision of whose case is more " worthy. "

My thoughts.

Maggi

MGB Wannabe

July 28, 2000

Dr. Rutledge, bless your heart. I love you doctor. You are truly an angel.

I can sympathize with you for what is weighing on your heart. I wish I could

do something to help. I live in Charlotte, but I have spent 30 some odd

years in the health care field. I wish I could take some of the load off.

Unfortunately, I am not a doctor. I can only pray that the burden is lifted

from you because I know just from meeting you that this was not an easy

decision for you to make. I have told you numerous times " I THINK YOU ARE A

GENIUS. " I just know in my heart that everything will be OK for all

involved. I called Debbie today and told her that we love her and we

appreciate what all of you are doing. I will be praying for all of us Dr.

Rutledge. Especially for you and your staff. May God bless you is my prayer.

(waiting to start a new life)

July 28, 2000

I think those are great ideas!

I 2nd the motion...... for Dr R's consideration!

Joannie

Irving, Tx

in FL wrote:

> Hi Dr. Rutledge !

>

> I have been thinking and thinking about this since I first read your

> post

> this afternoon. I truly do not envy your position, I always loved to

> read

> your posts, because you are just about the coolest Doctor i've ever

> seen,

> but it is obvious how upset this makes you from the tone of your

> emails, we

> can all see how hard this is, and no decision that is made will be

> great

> news for everyone...what's the saying...you can please some of the

> people

> some of the time..but not all of the people all of the

> time...anyway...I

> have some suggestions I'd like to add if I may...

>

> #1 The online patient info sheet takes about two hours at the most

> for us

> to complete, could you maybe set a cut off date for all Patients to

> have

> their online info sheets submitted to your office by July 31st. I

> first

> thought maybe Aug 15th, but if you are receiving 20 PI forms a day,

> you're

> talking about another 340 patients. Now what you maybe could do is

> that

> anyone submitting between 8/1 - 8/15 is required to obtain insurance

> approval themselves, and after 8/15 do not accept anymore PI forms for

> a

> while. You could do like an enrollment period like the insurance

> companies

> do. Perhaps take the next 6 months to a year to get to a position

> where you

> feel your Standard of Care is not jeopardized, and then perhaps open

> the

> " enrollment " period to maybe the first 500 patients, then close down

> again

> for 6 months. Insurance approval, well at least mine is good for 6

> months.

> This will enable people the time to get their packet together, get

> their

> insurance approval and be ready to go when the enrollment period

> begins

> again. I know it is seems easy for me to say, but it really is

> not. I

> sent in my packet to you yesterday, and am hoping for a date in Sept,

> but I

> know if I were in the middle of this, I would still wait for you.

> This at

> least does not elimate those that may never have the money for this

> surgery,

> it just delays it a bit, and at the same time gives you time to give

> the

> care that you feel comfortable with, and also elevates the time your

> very

> over worked staff spends in obtaining insurance approval.

>

> >

> >Reply-To: MiniGastricBypass (AT) egroups (DOT) com

> >To: <MiniGastricBypass (AT) egroups (DOT) com>

> >Subject: Re: Coming Changes

> >Date: Fri, 28 Jul 2000 16:23:00 -0400

> >

> >Hi,

> >

> > > Dr. R what about the ones that have already been approved by their

>

> >insurance

> > > companies and finishing up their packets for a surgery date in

> Aug.....

> >

> >For patients that are already in progress we will continue to proceed

> as in

> >the past.

> >

> >I have to do something and I am asking for advice and suggestions.

> >

> >I simply cannot manage all of the patients that want to have the

> surgery

> >and

> >the insurance battles are wearing me down.

> >

> >Suggestions wanted.

> >

> >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.

> > Re: Coming Changes

> >

> > > Dr. R what about the ones that have already been approved by their

>

> >insurance

> > > companies and finishing up their packets for a surgery date in

> >Aug.....please

> > > reconsider this was my only hope.....you should have received my

> >approval

> > > letter by now...I have a copy that they sent to me also,,,

> > >

> > > Kendra in WV

> > >

> > > 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

> > >

> >

> >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

> >

>

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>

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July 28, 2000

Dear Dr. Rutledge,

This has been a lot to take in tonight. Thank you for trying to

relieve the panic about not changing anything for those of us in

process.

I have really liked some of the last suggestions. I think that Sara

has some good points. The whole idea of a cut off and catch up time

sounds very important to me. Any one would be overwhelmed getting

that many daily requests online and in emails. I think that some

version that works for you between cut off dates and the idea of

enrollment period should really help your office and you feel like

you

are gaining back control. Who knew the power of the internet??!

I think that the cut off date should be no sooner than Aug 5th to

give

people a week. I liked the idea of the 15th, but didn't think about

all the extra patient forms between now and then.

I do think that Sara's thought about your personal email makes some

sense now. I know you must love the idea of being so open and

available to your patients and potential patients. That is one

reason

we are drawn to you, but it only hurts your PR to not be able to get

back to people when the website invites them to write you 24hours a

day.

I also think it is only reasonable to expect us to do us much leg

work

as possible for our insurance; however, I do know that mine has said

they cannot do anything until they hear from a doctor. So it sounds

like your form letter is essential if you are to continue to take

insurance payments. It may also be necessary for us to get insurance

to cover the hospital and other expenses. I do think others should

be

able to help you with these letters as well. I also assumed that

someone in your office was the insurance person. I agreee you almost

never hear of any medical clinic or practice that doesn't hire their

own or contract out. It is way too much work for people with other

important clinic duties.

Also, to a certain extent I understand 's reasoning about

limiting harder at risk surgeries, but maybe a more humane solution

after you get a hold of the numbers by using cut offs and enrollment

periods would be to take only a small number per month, say 2. Maybe

you already do that.

Just one more brain storm idea about the selection process. If after

other measures to decrease the number of new patients, it still seems

unreasonable or first come first serve doesn't work, random selection

of pre-qualified patients might be a solution to having to decide who

deserves more or is in greater need. I don't know exactly how this

would work, its just a thought. I know some places who use it for

hiring because way too many qualified people apply.

I do also agree that you may need to reassess what you want out of

this and what you and your family can give and sacrifice of your

personal life for this wonderful cause you have found as a career.

Morbid Obesity is an epidemic in this country. There will never be

enough of you and your talented use of current technology has opened

you up to not just NC, but the world - that's a big door.

Thanks for asking for our input You are unique, talented and

creative. Put a stop on the influx and take some time to let your

ideas gel. We will pray for your creative inspiration:)

Thanks for listening!

Laurie In Ohio

July 28, 2000

Hi Dr. Rutledge,

It breaks my heart to think that others in my situation may not be able to have

the hope that this surgery offers. My surgery is next week, but still this

email made me very sad, although I had thought that something like this was

going to happen at some point since you are only one person and can only do so

many surgeries, and I know that the insurance problems and hassles are awful.

I think that it will take several different courses of action to solve these

problems. Here are some suggestions that I have been thinking about:

1. Do whatever you can to ease the burden that dealing with everyone's

insurance causes you, but try not to rule out patients who have to use

insurance to be able to have this surgery. It seems that the decision of who

has the surgery should not have anything to do with how much money they have.

Perhaps you could raise your fee to hire one (or more) person to handle only

insurance, or hire an outside company to handle the insurance and billing for

you as others have suggested. I know that a couple of years ago my OB/GYN told

me that he had several (I think he said 5) people in his office just to handle

insurance because of all the many different insurance companies out there and

all the different hoops each of them make their clients jump through. Now five

employees just to handle the insurance for a practice with two doctors seems

ridiculous, but I did get the impression that at least he and his partner

didn't have to do anything about insurance themselves, which left them free to

deal just with patients. If you increase your fee, that should cover the

salaries of however many employees you would need to deal with the insurance

companies. You might try to hire former patients who have already had some

experience dealing with these companies and who know the circumstances of the

patient so well. (I'd apply!) I think that a good, astute employee could

handle filling in the letter for the insurance company from the online patient

application form, instead of you having to do it. You might want to glance

over them before they were sent off, but that should still save you a lot of

time.

2. Now, the larger problem of the huge number of patients wanting (and needing)

the MGB. It would be great if the solution to this could still leave people

with hope that at some point they would be able to have the MGB. I do think

you will need to have cutoff date(s) for submission of packets for surgery

approval. I say dates, plural, because once the number of patients has been

whittled down after the first date, then you could open it up again for

submission of more packets and have another cutoff date set to avoid it

becoming overwhelming again. You could publicize the cutoff date on the web

site and on this list so that people would know at least a little in advance

and could plan accordingly. I do think it would be great if those people

already in process now could be accommodated, even if they have to wait a while

for a surgery date. Then new people would know up-front from the web site and

this list that they would have perhaps quite a while to wait, and then no one

already started in the process would have their hopes dashed. Those who know

they will have to wait could use the time to get all the information they need

to make their decision, and, if you have inside or outside help hired to just

handle insurance and write the initial and appeal letters to the insurance

companies for you, then the people waiting could possibly start wading through

the insurance process before they send their packet in. Then, once packets

were being accepted again they could already have insurance approval, or have

determined that they will self-pay. Perhaps you should only accept packets

from those that already have insurance approval or who are going to self-pay.

In the meantime you can get one (or more) other surgeons to join you in doing

the MGB. If that will take about a year, as you said, then about a year from

now you could probably open things up again and hopefully handle all those

needing and wanting the MGB. Perhaps you could tell the people who have more

difficult problems such as needing revisions of other weight loss surgeries, or

who are outside of the guidelines in some other way, but who " could " have the

MGB, that they will need to wait for the year or so until the load lightens

before they can be considered. (But I would love it if you could still do the

few who are in that category who have already contacted you about it.) I don't

see this as a hopeless situation because it seems to me that if some measures

are taken now to lighten things up and to get one or more other surgeons on

board, then the longest people will probably have to wait is a year, or a

little more. That seems like a long time, but as I look back I realize that I

have been working toward this for almost 7 months anyway.

So, what I am saying is choose a date to stop accepting packets for the time

being. It will probably need to be fairly soon, but allow those in the midst

of the process to get theirs in. Publicize that date well so that all the new

people know that packets won't be accepted after that (for a while), but let

everyone know that they can still continue with their research about the MGB

and possibly with getting insurance approval, but they can't be considered for

it until the next " window " which will be when the current case load lightens

up.

Also, you might want to change your email address and give it out only to those

already approved for surgery and to post-ops. Perhaps someone else in the

office could answer the emails from everyone else (especially if you hire

someone else to take the burden of insurance hassles off of the others). They

could always ask you if something came up that they didn't know the answer to,

and that should cut down on the huge number of emails you get every day.

Please don't rule out people who have to use insurance. I know that I would

rather that you raise your fee and use that to hire more people or an outside

company to deal with that for you and Debbie and Barbara and others in the

office. I am serious that I will come and work for you and deal with those

horrible insurance companies and write the letters for you to them.

I hope and pray that a solution can be found which will still allow as many

people as possible to have the MGB, even if they have to wait.

Thank you for all you do, Dr. Rutledge. You have saved the lives of many

people. I will see you in a few days for my surgery. Don't worry; I have

great faith that this procedure is so important to so many people that a way

will open up for the problems to be dealt with.

Sincerely,

Sara Schutz

" Rutledge, M.D., F.A.C.S. " wrote:

> Hi,

>

> We are overwhelmed.

>

> Our database of preop patients contains over 1500 patients and we get 5-10

> completed new patients applications per day.

>

> I get over 500 emails per day and I simply cannot answer all of them.

>

> Even with the expected addition of three new staff members and operating in

> two rooms during the day our office is overwhelmed with new patients.

>

> While this seems good at first blush, I am afraid that I can no longer keep

> up good quality care that I want to provide.

>

> I have to use some method of decreasing my patient load.

>

> To try and decrease our patient load we have already stopped doing elective

> revisions of other types of failed weight loss surgery and have become

> stricter in relation to our weight and age limits. In the past we had taken

> out a few small local advertisements and we have pulled all of these to try

> and decrease new patient appointments.

>

> We still have many more patients than I could ever possibly take care of.

>

> I have reviewed my practice in detail and I have talked with Debbie about

> what she does and what she likes and doesn't like about the job.

>

> Clearly the most time consuming and unpleasant part of the job is dealing

> with the insurance companies.

>

> Therefore, our tentative plan is to move over the next month to no longer

> accept insurance payment for the surgery. We could still provide the preop

> letters to patients and help patients file for insurance reimbursement post

> procedure but our efforts in this area would be limited to submitting the

> bill to the company. This would eliminate a tremendous amount of frustration

> and paper work. The ridiculous amount of time and effort spent on hold and

> trying to address the Byzantine rules and regulations dreamed up by

> insurers would be eliminated.

>

> I would be interested in advice and suggestions about this plan.

>

> I recognize that many patients will be prevented from having the surgery, at

> this time but I can only do so many operations and I do not want to

> compromise the quality of the care that I provide.

>

> Please give me your thoughts and feelings about this very difficult issue.

>

> 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.

>

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July 28, 2000

In a message dated 7/28/00 2:35:27 PM Pacific Daylight Time,

Dr_Rutledge@... writes:

<< Hi,

No one who is here now should be excluded. That is my thought.

We are talking about setting a date to affect future patients.

What would be fair?

Everyone who has submitted their form up to a certain date should be OK.

When?

RR

>>

I just have to say, how cool is this that we have a physician who is asking

us all these questions!? The fact that you value our opinions and want this

to be a " group effort " speaks volumes for your character!

I know that other WL docs use a bit stricter standards-- higher BMI's, higher

weights. I guess this could be a starting point while you teach others your

procedure. I do believe, however, that more docs are the key.

As for insurance, why not submit the online form and then completely stay out

of the rest of the approval process?

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(

July 28, 2000

Dr. R.,

Well, I have to admit that I got a huge lump in my throat when I saw

your post titled " Coming Changes " . However, I am amazed at the volume

that you and your staff have been able to handle thus far.

I have been fighting with my insurance company and will hear on

August 8th whether or not my employer will allow me to switch

insurance companies to one that does cover the procedure. I have been

looking toward that day with great hope.

When you say that your office would stop filing for pre-approvals for

the procedure, do you mean just your fee? Would the hospital and

anesthesiologist bills be handled the same way? How would you handle

the patients that you have already started with insurance pre-

approval (like me)?

This does put a kink in my plans but I totally understand your

reasons. I am going to continue working towards having the procedure

and will figure out someway to be successful.

I will continue to think of ideas to help with your volume of

patients.

Kindest Regards,

Aimee Howes

July 28, 2000

I completely agree with Joanie - 's ideas seem very reasonable,

and quite workable - and I say that knowing that I'd fall outside

the

" target dates " , so I'd have to wait.

I also think a lot of people are freaking unnecessarily, we're

whining, and we're making it harder for the Doc! Look back on the

string of responses and questions - an awful lot of 'em are

little more than thinly disguised requests for personal exceptions.

Incidently, Dr. R. - the way your office has been handling the

insurance is WAY beyond the call - just submit the forms and let US

do

the fighting, with occasional letters of support from your office.

If

we aren't dedicated enough to fight for ourselves, we certainly

shouldn't expect you to do it.

I know I sound aggressive and negative - but we'd better get it

together, folks, or Dr. R. won't have the energy or will to keep

going.

--Aimee

> I think those are great ideas!

> I 2nd the motion...... for Dr R's consideration!

>

> Joannie

> Irving, Tx

>

> in FL wrote:

>

> > Hi Dr. Rutledge !

> >

> > I have been thinking and thinking about this since I first read

your

> > post

> > this afternoon. I truly do not envy your position, I always

loved

to

> > read

> > your posts, because you are just about the coolest Doctor i've

ever

> > seen,

> > but it is obvious how upset this makes you from the tone of your

> > emails, we

> > can all see how hard this is, and no decision that is made will be

> > great

> > news for everyone...what's the saying...you can please some of the

> > people

> > some of the time..but not all of the people all of the

> > time...anyway...I

> > have some suggestions I'd like to add if I may...

> >

> > #1 The online patient info sheet takes about two hours at the

most

> > for us

> > to complete, could you maybe set a cut off date for all Patients

to

> > have

> > their online info sheets submitted to your office by July 31st.

I

> > first

> > thought maybe Aug 15th, but if you are receiving 20 PI forms a

day,

> > you're

> > talking about another 340 patients. Now what you maybe could do

is

> > that

> > anyone submitting between 8/1 - 8/15 is required to obtain

insurance

> > approval themselves, and after 8/15 do not accept anymore PI

forms

for

> > a

> > while. You could do like an enrollment period like the insurance

> > companies

> > do. Perhaps take the next 6 months to a year to get to a position

> > where you

> > feel your Standard of Care is not jeopardized, and then perhaps

open

> > the

> > " enrollment " period to maybe the first 500 patients, then close

down

> > again

> > for 6 months. Insurance approval, well at least mine is good

for

6

> > months.

> > This will enable people the time to get their packet together,

get

> > their

> > insurance approval and be ready to go when the enrollment period

> > begins

> > again. I know it is seems easy for me to say, but it really is

> > not. I

> > sent in my packet to you yesterday, and am hoping for a date in

Sept,

> > but I

> > know if I were in the middle of this, I would still wait for you.

> > This at

> > least does not elimate those that may never have the money for

this

> > surgery,

> > it just delays it a bit, and at the same time gives you time to

give

> > the

> > care that you feel comfortable with, and also elevates the time

your

> > very

> > over worked staff spends in obtaining insurance approval.

July 29, 2000

Hi Dr. Rutledge,

I understand that you must dislike the insurance company thing. It is

awful that they can get away with trying to deny patients something

that can very likely save their life.

I have considered self-pay, but I was concerned about what would

happen if I did self-pay and then had complications. Would they pay

for the complications even though they did not approve payment of the

original surgery? I doubt it.

Health care has gotten much too expensive to not have insurance to

cover such things. If you eliminate insurance, you are only serving

the more wealthy in our society. I didn't think that was what you

were about.

As others suggested, have us pay something up front to help with

handling the insurance. Or, give us the form letter and let us fill

in the info ourselves, send it back to you, and you can send it in

because I think you probably have to be the one to actually send in

the request for pre-approval. Perhaps one of the new people you hire

could do the insurance thing exclusively. It seems then they could

concentrate on just that without other things to deal with. I'm sure

Debbie is overwhelmed having to deal with this as well as so many

other things.

What about this scenario:

1. We fill out and submit our Patient Information Form.

2. Based on the Patient information, you let the patient know

if he/she is still a candidate for surgery.

3. Have us send you the 12 step package.

4. If, based on the package, the patient is still considered

and candidate for the procedure, you submit the request for

pre-approval. The advantage to this is that you will be able to

also submit the hard evidence of medical records to the insurance

company the first time. Perhaps this would minimize the initial

rejections.

5. If our insurance is rejected, we work with (or some

other attorney willing to represent us) at some

pre-determined rate to resolve any issues. There must be a

pattern of things that are omitted in the initial requests.

Perhaps can suggest what kind of patterns she has seen

and report any new things as they come along.

I am very grateful that you are considering grandfathering people

already in the process.

Thanks for your consideration,

Kris Kuhl

> Hi,

>

> I think everyone that is now " in process " should expect that they

will be

> treated under the " old " rules.

>

> The " new " rules are up for discussion.

>

> I am asking for help and advice.

>

> Nothing is fixed yet.

>

> But I am sure it is obvious that I can only operate upon a limited

number of

> patients.

>

> We have to do something to limit the patients.

>

> And I really honestly do dislike the insurance company thing.

>

> 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

> >

> > > Hi,

> > >

> > > We are overwhelmed.

> > >

> > > Our database of preop patients contains over 1500 patients and

we get

> 5-10

> > > completed new patients applications per day.

> > >

> > > I get over 500 emails per day and I simply cannot answer all of

them.

> > >

> > > Even with the expected addition of three new staff members and

operating

> > in

> > > two rooms during the day our office is overwhelmed with new

patients.

> > >

> > > While this seems good at first blush, I am afraid that I can no

longer

> > keep

> > > up good quality care that I want to provide.

> > >

> > > I have to use some method of decreasing my patient load.

> > >

> > > To try and decrease our patient load we have already stopped

doing

> > elective

> > > revisions of other types of failed weight loss surgery and have

become

> > > stricter in relation to our weight and age limits. In the past

we had

> > taken

> > > out a few small local advertisements and we have pulled all of

these to

> > try

> > > and decrease new patient appointments.

> > >

> > > We still have many more patients than I could ever possibly

take care

> of.

> > >

> > > I have reviewed my practice in detail and I have talked with

Debbie

> about

> > > what she does and what she likes and doesn't like about the job.

> > >

> > > Clearly the most time consuming and unpleasant part of the job

is

> dealing

> > > with the insurance companies.

> > >

> > > Therefore, our tentative plan is to move over the next month to

no

> longer

> > > accept insurance payment for the surgery. We could still

provide the

> preop

> > > letters to patients and help patients file for insurance

reimbursement

> > post

> > > procedure but our efforts in this area would be limited to

submitting

> the

> > > bill to the company. This would eliminate a tremendous amount of

> > frustration

> > > and paper work. The ridiculous amount of time and effort spent

on hold

> and

> > > trying to address the Byzantine rules and regulations dreamed

up by

> > > insurers would be eliminated.

> > >

> > > I would be interested in advice and suggestions about this plan.

> > >

> > > I recognize that many patients will be prevented from having the

> surgery,

> > at

> > > this time but I can only do so many operations and I do not

want to

> > > compromise the quality of the care that I provide.

> > >

> > > Please give me your thoughts and feelings about this very

difficult

> issue.

> > >

> > > 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.

> > >

> > > 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

> > >

> >

> > 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

> >

July 29, 2000

,

I understand what you are saying but, I started this process back in

February and in June was told to wait 6 months. I just feel that I should

also be grandfathered in. I understand the amount of additional time and I

think he should charge accordingly. I know of alot of patients that have

had surgeries done, not necessarily a weight loss surgery but those

surgeries also involved scar tissue. ARe we then saying anyone with any

type of previous surgery should not be considered at all? Is this fair? If

I were just applying today online, then Dr. R should say I am no longer

doing revisions, however, since I have been in this process since February I

just wish he would consider me. Sharon

Re: Coming Changes

> Sharon Cindy wrote:

> >

> > DR. Rutledge:

> >

> > I agree with the being grandfathered in. I had previous weight loss

> > surgery done and back in June you asked me to wait 6 months. Since all

of my

> > paperwork was in and completed, won't you consider grandfathering us

> > in. I, too, have been looking forward and practically living for this

> > surgery. I have been waiting patiently or maybe not so patiently for

November to

> > approach you again. Please tell me my hopes are not for nothing.

> > Sharon

>

> Sharon,

>

> When Dr. R. is trying to decide on guidelines for his future patient

> load, if you think about it, should he help 7-8 patients who have never

> had weight loss surgery or spend the same 4 hours doing one revision?

>

> I'm not trying to be a butthead about this, I'm just trying to look at

> it objectively and if it were my call to make, this is one of the issues

> I would be weighing and how I see it.

>

> If it came down to it, don't you have other options, i.e., couldn't you

> get a lap RNY? What type of surgery did you have before? How hard will

> it be to reverse?

>

> Kind regards,

>

> 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

>

July 29, 2000

In a message dated 7/29/00 4:51:10 PM Eastern Daylight Time,

Sharons43@... writes:

<< ,