I need some help..(kinda long)

[Guest guest]

Well, I got approved for my surgery--WHOOP! Now I am entering the

daunting phase of figuring out how much my insurance company will pay

the doctor's office. If I cannot get specific figures, I have been

told by Joanne at Dr. Rabkin's office that I will need to pay for

everything in full and *I* will be the one to get reimbursed from the

insurance company.

This is what I have been able to get so far. I have a 20% co-

insurance up to $1000 per year, plus a $300 deductible. I have met

my deductible for the year and a small part of my co-insurance. I

have been given a letter from the Guardian that states the CPT codes

(supplied by the Doc's office) and the Doctor's charges for the codes

but NO specific amounts. My insurance will only pay what is

reasonable and customary for the procedure and the area. Four of the

six codes are reasonable and customary, 2 are not and they are the

big ones. I have been told that insurance companies will not give

out specific numbers due to insurance fraud. I can understand that,

yet why in the heck do I pay insurance only to have to turn around

and self-pay and wait to get reimbursed? I am frustrated.

Now, I have also been told by Joanne that I will not get a date for

surgery until they have recieved a 'disclosure of legality' or full

payment from me. Has anyone else been told this? I do not

understand why this is so difficult. I really need some advice and

anything you can impart on me will be so appreciated.

Thanks in advance!!

Liz

[Guest guest]

Well, I got approved for my surgery--WHOOP! Now I am entering the

daunting phase of figuring out how much my insurance company will pay

the doctor's office. If I cannot get specific figures, I have been

told by Joanne at Dr. Rabkin's office that I will need to pay for

everything in full and *I* will be the one to get reimbursed from the

insurance company.

This is what I have been able to get so far. I have a 20% co-

insurance up to $1000 per year, plus a $300 deductible. I have met

my deductible for the year and a small part of my co-insurance. I

have been given a letter from the Guardian that states the CPT codes

(supplied by the Doc's office) and the Doctor's charges for the codes

but NO specific amounts. My insurance will only pay what is

reasonable and customary for the procedure and the area. Four of the

six codes are reasonable and customary, 2 are not and they are the

big ones. I have been told that insurance companies will not give

out specific numbers due to insurance fraud. I can understand that,

yet why in the heck do I pay insurance only to have to turn around

and self-pay and wait to get reimbursed? I am frustrated.

Now, I have also been told by Joanne that I will not get a date for

surgery until they have recieved a 'disclosure of legality' or full

payment from me. Has anyone else been told this? I do not

understand why this is so difficult. I really need some advice and

anything you can impart on me will be so appreciated.

Thanks in advance!!

Liz

[Guest guest]

Oh my goodness. :speechless:

> Hi Liz,

> I was scheduled for a consult with Dr Rabkin, which I later

cancelled when I

> chose another Dr to do my surgery. In the papers they sent me prior

to the

> consult, they said that they require the full $12,000 be paid

before they

> will set up a surgery date. Then, if I want them to submit it to my

> insurance, they charge 7.5%...$900! That was a major reason I

decided against

> not even having a consult with Dr Rabkin; $900 seems very, very

greedy to me,

> when other surgeons automatically submit it for no charge. I have

Blue

> Cross/Shield PPO.

> Sheryl

[Guest guest]

I heard this as well from one other person, but during my consult

with dr. rabkin & staff, this wasn't mentioned. Can anyone else

verify? I had my consult on 7/12 and am still waiting for them to

submit lomn to my insurance. While I know that some ppl. have been

waiting months, this has been really frustrating. I'm considering

going to another surgeon as well, even though my first choice is dr.

rabkin. I understand that they're busy, but really feel that it's

wrong that you can't even call them to check your status....

> Oh my goodness. :speechless:

>

> > Hi Liz,

> > I was scheduled for a consult with Dr Rabkin, which I later

> cancelled when I

> > chose another Dr to do my surgery. In the papers they sent me

prior

> to the

> > consult, they said that they require the full $12,000 be paid

> before they

> > will set up a surgery date. Then, if I want them to submit it to

my

> > insurance, they charge 7.5%...$900! That was a major reason I

> decided against

> > not even having a consult with Dr Rabkin; $900 seems very, very

> greedy to me,

> > when other surgeons automatically submit it for no charge. I have

> Blue

> > Cross/Shield PPO.

> > Sheryl

[Guest guest]

Have you considered Dr Keshishian in Delano..... He and his staff are great

and the hospital seems very caring and knowledgable of bariatric surgeries.

My partner and I are seeing him. His fees are much more reasonable as well!

Good Luck, Janne

>

>Reply-To: duodenalswitch

>To: duodenalswitch

>Subject: Re: I need some help..(kinda long)

>Date: Thu, 02 Aug 2001 06:24:21 -0000

>

>I heard this as well from one other person, but during my consult

>with dr. rabkin & staff, this wasn't mentioned. Can anyone else

>verify? I had my consult on 7/12 and am still waiting for them to

>submit lomn to my insurance. While I know that some ppl. have been

>waiting months, this has been really frustrating. I'm considering

>going to another surgeon as well, even though my first choice is dr.

>rabkin. I understand that they're busy, but really feel that it's

>wrong that you can't even call them to check your status....

>

>

>

>

>

>

> > Oh my goodness. :speechless:

> >

> > > Hi Liz,

> > > I was scheduled for a consult with Dr Rabkin, which I later

> > cancelled when I

> > > chose another Dr to do my surgery. In the papers they sent me

>prior

> > to the

> > > consult, they said that they require the full $12,000 be paid

> > before they

> > > will set up a surgery date. Then, if I want them to submit it to

>my

> > > insurance, they charge 7.5%...$900! That was a major reason I

> > decided against

> > > not even having a consult with Dr Rabkin; $900 seems very, very

> > greedy to me,

> > > when other surgeons automatically submit it for no charge. I have

> > Blue

> > > Cross/Shield PPO.

> > > Sheryl

>

>

>----------------------------------------------------------------------

>

[Guest guest]

OHHH!!

YES!!!!!

If I could have afforded to travel to Delano, Dr. K. was my #1

choice.. He is extremely caring, & his patients all adore him (AND his

staff- bar none- very important!). If you can go to Delano, he's

definitely worth consideration!

My .02-

Liane

> > > Oh my goodness. :speechless:

> > >

> > > > Hi Liz,

> > > > I was scheduled for a consult with Dr Rabkin, which I later

> > > cancelled when I

> > > > chose another Dr to do my surgery. In the papers they sent me

> >prior

> > > to the

> > > > consult, they said that they require the full $12,000 be paid

> > > before they

> > > > will set up a surgery date. Then, if I want them to submit it

to

> >my

> > > > insurance, they charge 7.5%...$900! That was a major reason I

> > > decided against

> > > > not even having a consult with Dr Rabkin; $900 seems very,

very

> > > greedy to me,

> > > > when other surgeons automatically submit it for no charge. I

have

> > > Blue

> > > > Cross/Shield PPO.

> > > > Sheryl

> >

> >

>

>---------------------------------------------------------------------

-

> >

[Guest guest]

Yes Liane.... it can be expensive to travel... It is a 11 hr drive for us

and we have to stay in a motel.... I'm not sure how we will make all the

finances work, but we feel it is worth it in the bigger picture to have the

balance of competence and caring.... good luck, Janne

>

>Reply-To: duodenalswitch

>To: duodenalswitch

>Subject: Re: I need some help..(kinda long)

>Date: Thu, 02 Aug 2001 09:06:38 -0000

>

>OHHH!!

>YES!!!!!

>If I could have afforded to travel to Delano, Dr. K. was my #1

>choice.. He is extremely caring, & his patients all adore him (AND his

>staff- bar none- very important!). If you can go to Delano, he's

>definitely worth consideration!

>My .02-

>Liane

>

>

> > > > Oh my goodness. :speechless:

> > > >

> > > > > Hi Liz,

> > > > > I was scheduled for a consult with Dr Rabkin, which I later

> > > > cancelled when I

> > > > > chose another Dr to do my surgery. In the papers they sent me

> > >prior

> > > > to the

> > > > > consult, they said that they require the full $12,000 be paid

> > > > before they

> > > > > will set up a surgery date. Then, if I want them to submit it

>to

> > >my

> > > > > insurance, they charge 7.5%...$900! That was a major reason I

> > > > decided against

> > > > > not even having a consult with Dr Rabkin; $900 seems very,

>very

> > > > greedy to me,

> > > > > when other surgeons automatically submit it for no charge. I

>have

> > > > Blue

> > > > > Cross/Shield PPO.

> > > > > Sheryl

> > >

> > >

> >

> >---------------------------------------------------------------------

>-

> > >

[Guest guest]

Liz,

This is a well known issue with Dr. Rabkin. If you are willing to go

with open surgery than you can choose Dr. Anthone down here at USC or

Dr. K in delano. You could also travel up to Eugene and see Dr.

Welker - I believe he will use the lap. It really depends on what

insurance company you have.

If money is really tight then you should pick a doctor that is

contracted with your insurance company. Dr. Rabkin stopped taking

all contracts as of Jan 1,2001 - that is one of the reasons I have

chosen Dr. Anthone.

Just to give you an idea, you can probably expect the R & C costs to be

about $3000-$4000, so you will probably get maybee $2500 for the

insurnance companies, and you will be resoponsible for the rest!

Now the good news, as long as your insurance is contracted with the

hospital the Dr. R uses, you will have that covered. That is the

really expensive stuff (tens of thousands of dollars).

I here a lot of talk about the cost of travel and the costs of

insurance payments for better insurance. ly, I don't get it. I

can't imagine that the travel costs will be several thousand dollars

that you will have to pay Dr. R.

On the other hand you are approved and it would be quickest to stay

with Dr. R, so you have to decide if the savings is worth the hassle.

Hull

> Well, I got approved for my surgery--WHOOP! Now I am entering the

> daunting phase of figuring out how much my insurance company will

pay

> the doctor's office. If I cannot get specific figures, I have been

> told by Joanne at Dr. Rabkin's office that I will need to pay for

> everything in full and *I* will be the one to get reimbursed from

the

> insurance company.

>

> This is what I have been able to get so far. I have a 20% co-

> insurance up to $1000 per year, plus a $300 deductible. I have met

> my deductible for the year and a small part of my co-insurance. I

> have been given a letter from the Guardian that states the CPT

codes

> (supplied by the Doc's office) and the Doctor's charges for the

codes

> but NO specific amounts. My insurance will only pay what is

> reasonable and customary for the procedure and the area. Four of

the

> six codes are reasonable and customary, 2 are not and they are the

> big ones. I have been told that insurance companies will not give

> out specific numbers due to insurance fraud. I can understand

that,

> yet why in the heck do I pay insurance only to have to turn around

> and self-pay and wait to get reimbursed? I am frustrated.

>

> Now, I have also been told by Joanne that I will not get a date for

> surgery until they have recieved a 'disclosure of legality' or full

> payment from me. Has anyone else been told this? I do not

> understand why this is so difficult. I really need some advice and

> anything you can impart on me will be so appreciated.

>

> Thanks in advance!!

> Liz

[Guest guest]

Thanks, Chris..

I was not aware that when Doc's are not in network, they require 100%

upfront. Is it just that they never get paid? I am just shocked

that peeps can afford this on their own. If I have to pay for it

myself I might as well go to Spain and have a vacation out of it

too.

Also, I was under the impression that none of these doctors are in

network.. I guess that is false??

> > Well, I got approved for my surgery--WHOOP! Now I am entering

the

> > daunting phase of figuring out how much my insurance company will

> pay

> > the doctor's office. If I cannot get specific figures, I have

been

> > told by Joanne at Dr. Rabkin's office that I will need to pay for

> > everything in full and *I* will be the one to get reimbursed from

> the

> > insurance company.

> >

> > This is what I have been able to get so far. I have a 20% co-

> > insurance up to $1000 per year, plus a $300 deductible. I have

met

> > my deductible for the year and a small part of my co-insurance.

I

> > have been given a letter from the Guardian that states the CPT

> codes

> > (supplied by the Doc's office) and the Doctor's charges for the

> codes

> > but NO specific amounts. My insurance will only pay what is

> > reasonable and customary for the procedure and the area. Four of

> the

> > six codes are reasonable and customary, 2 are not and they are

the

> > big ones. I have been told that insurance companies will not

give

> > out specific numbers due to insurance fraud. I can understand

> that,

> > yet why in the heck do I pay insurance only to have to turn

around

> > and self-pay and wait to get reimbursed? I am frustrated.

> >

> > Now, I have also been told by Joanne that I will not get a date

for

> > surgery until they have recieved a 'disclosure of legality' or

full

> > payment from me. Has anyone else been told this? I do not

> > understand why this is so difficult. I really need some advice

and

> > anything you can impart on me will be so appreciated.

> >

> > Thanks in advance!!

> > Liz