Re: No longer Accepting Insurance

[Guest guest]

Dear Ken,

In your opinion, do you think you lose leverage with the insurance company

if you go ahead and pay for the surgery out of your pocket and then attempt

to recoup the costs after the surgery has already been done. I've been held

hostage waiting for insurance approval and the idea of proceeding with or

without insurance approval is appealing. Good luck in three weeks!

Tarri in Missouri

No longer Accepting Insurance

>

> I have not talked to Dr. Rutledges office, but, in my opionion, Dr.

> Rutledge will take insurance payment, he just does not want to be

> involved in the hassle to get it. Look at it from his point of view.

> He is a surgeon and he maintains an office staff. This is a

> relatively new procedure and there is a ton of work in managing this.

> Dr. Rutledge is responsible for the clinics, surgery, post surgery

> follow up, web updates, answering email, doing the long term follow

> up of patients, and the 12 over things I don't even know about. All

> of this is a draw on his resources. I think he has done a tremendous

> job in keeping costs down. Insurance approval is a large draw on his

> people. He is a surgeon, but he is a business too. Before the managed

> care, PPO's and HMO's, I remember doctors regularily refusing to

> accept insurance. You pay the bill, and then you go get reimbursement

> from your insurance company. I don't think this is unreasonable. You

> go to your insurance company, in conjunction with your personal

> physician, and request approval. When your approved and can prove it

> to Dr. R, I'll bet that is all he needs. Or you can do like I am. I

> was denied an open Rny here in Michigan and am self paying with Dr. R

> and will fight the insurance comopany after the fact. There is a lot

> of work in this insurance approval game and it really isn't

> reasonable to expect the Doctors office to absorb those costs.

>

> Just my 2 cents.

>

> Surgery in 3 weeks!

>

> Ken Grakauskas

>

>

>

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[Guest guest]

Tarri;

I really don't think I will lose leverage, I actually think I will

gain leverage. This may be a misplaced notion, but I'll let you know

the outcome. I am taking a second mortgage on my house to pay for

this. My family doctor feels this is medically necessary and it has

been presented as such to the insurance company. I can now make the

case that it, in fact, was so medically necessary and that I believed

that it was so strongly that I paid out of pocket to make sure

something that was a medically neessary action took place. I think it

adds conviction to the story, you know? If you were bleeding on the

steps of a hospital that was not " in plan " would you be healed and

then work it out or would you bleed to death waiting for the

insurance company to finish pontificating about which hospital to

send you to?

Our HMO is really screwey and I don't know how this is going to end

up. I was denied, but then a month later, they sent out a new

benefits package with bariatric surgery being accepted with a 50%

copay. Add to that, I'm going out of plan to get this done. They may

not pay, and I've accepted that. I'm going to be driving the same old

car for another 4 years, but I'm going to be thin doing it! At least

if it breaks down, I won't mind walking as much! LOL. Seriously

though, this is the most important thing to me personally, at this

point in my life and I want it done. It will hurt to have to pay for

it but the weight hurts more.

Impatiently waiting - 3 weeks to surgery

Ken Grakauskas

> Dear Ken,

> In your opinion, do you think you lose leverage with the insurance

company

> if you go ahead and pay for the surgery out of your pocket and then

attempt

> to recoup the costs after the surgery has already been done. I've

been held

> hostage waiting for insurance approval and the idea of proceeding

with or

> without insurance approval is appealing. Good luck in three weeks!

> Tarri in Missouri