Re: Dr. Elariny and DS surgeons in SC PA or MD

[Guest guest]

Hi and thanks for the responses. I have an appointment w/ Dr.E next month!

I even talked with him personally on the phone about insurance problems. My

insurance will not pay for obesity surgery unless it is medically necessary,

and morbid obesity is not a medical necessity. I emailed bunches of people

from Alabama with Bluecross PPO insurance to see if they had any problems

getting coverage. One person emailed me back saying the insurance company

was bluffing. I don't know, I guess I'll find out. Dr. E. said in VA there

is a law that obesity be covered by any insurance issued to a VAian. I

called PA to see if this is also true here, but obesity does not have to be

covered in PA. Darn Geographics!

Dr. E also told me that he is planning to set up a couple more hospitals in

the area so he can do 5-6 procedures a week instead ot 1-3. Good for him.

He was super on the phone, and I am looking forward to meeting him. I am

taking a friend with me to have a consult for the surgery,too. She has

medicare, and he said they are having trouble getting payment from medicare.

He said they will work with anyone to have this surgery and not to let the

insurance co. keep you from getting it or let them determine what type of

surgery you get. Apparently medicare will pay for RNY but not DS. He said

they code the procedure as accurately as possible to avoid fraud, and DS

requires two codes, which medicare isn't paying for.

If anyone has anything to add about Dr. E. I would appreciate hearing it. I

didn't know there was more than one type of DS surgery. I have no idea what

type Dr. E does. He was experienced in laporascopic procedures before he

entered Bariatric surgery. He said he has done around 100 lap DS to date.

So the journey begins....

Pam

[Guest guest]

Apparently medicare will pay for RNY but not DS. He said

they code the procedure as accurately as possible to avoid fraud, and DS

requires two codes, which medicare isn't paying for. >>>>

Medicare paid for both Mike and I with no problems. Paid in full.

Must be the way Dr Welker handles the codes but we had absolutly no trouble!

Judie

Re: Dr. Elariny and DS surgeons in SC PA or MD

> Hi and thanks for the responses. I have an appointment w/ Dr.E next

month!

> I even talked with him personally on the phone about insurance problems.

My

> insurance will not pay for obesity surgery unless it is medically

necessary,

> and morbid obesity is not a medical necessity. I emailed bunches of

people

> from Alabama with Bluecross PPO insurance to see if they had any problems

> getting coverage. One person emailed me back saying the insurance company

> was bluffing. I don't know, I guess I'll find out. Dr. E. said in VA

there

> is a law that obesity be covered by any insurance issued to a VAian. I

> called PA to see if this is also true here, but obesity does not have to

be

> covered in PA. Darn Geographics!

>

> Dr. E also told me that he is planning to set up a couple more hospitals

in

> the area so he can do 5-6 procedures a week instead ot 1-3. Good for him.

> He was super on the phone, and I am looking forward to meeting him. I am

> taking a friend with me to have a consult for the surgery,too. She has

> medicare, and he said they are having trouble getting payment from

medicare.

> He said they will work with anyone to have this surgery and not to let the

> insurance co. keep you from getting it or let them determine what type of

> surgery you get. Apparently medicare will pay for RNY but not DS. He

said

> they code the procedure as accurately as possible to avoid fraud, and DS

> requires two codes, which medicare isn't paying for.

>

> If anyone has anything to add about Dr. E. I would appreciate hearing it.

I

> didn't know there was more than one type of DS surgery. I have no idea

what

> type Dr. E does. He was experienced in laporascopic procedures before he

> entered Bariatric surgery. He said he has done around 100 lap DS to date.

>

> So the journey begins....

> Pam

>

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

>

[Guest guest]

<Apparently medicare will pay for RNY but not DS. He said

they code the procedure as accurately as possible to avoid fraud, and DS

requires two codes, which medicare isn't paying for. >>>>

Medicare paid for both Mike and I with no problems. Paid in full.

Must be the way Dr Welker handles the codes but we had absolutly no

trouble!>

I have Medicare also and they paid for their 80% and my supplemental (GHI)

paid for the rest, except for the nutritionist and a $200 hospitalization

deductible.

Rita Black

Open DS, Dr. Macura

4/23/01 400 lbs, BMI 63

5/1/01 391 lbs, BMI 61

5/22/01 368 lbs, BMI 58

6/21/01 350 lbs, BMI 55

7/31/01 328 lbs, BMI 51

5/22/01 368 lbs, BMI 58

6/21/01 360 lbs, BMI 55

7/31/01 328 lbs, BMI 51

8/23/01 320 lbs, BMI 50

[Guest guest]

and a $200 hospitalization

deductible.

Rita Black>>>>

Rita,

was that because your deductible hadnt been met at that time?

Judie

[Guest guest]

Ok Rita I get it......my supplemental at the time of surgery didnt have a

deductable but we switched supplementals in June so now its $300 we have to

pay for each hospitalization but thats ok becuz how often do you go to the

hospital anyway? Besides the new one allows us more freedom...we can go out

of network, choose any hospital and any doc or surgeon providing they take

Sterling.....and they do pay for wls if medical necessity!! (the other one

was the pits and we had to fight them) Over half of the people in wash

state, oregon and idaho left Regence due to the crappy service they got

including the fact they jacked up the premium double what it was!

Judie