Veteran LapBand Surgeon No Longer Accepting United Health Care Insurance

NewSho · March 14, 2006

For those Houston-area LapBand patients who might not have heard (on the phone or on other online forums), local LapBand (and bariatric) surgeon Dr Hadar Spivak is no longer accepting United Health Care (or UHC) insurance.

This might be of interest to other patients of his who travelled from out of the Houston area to have surgery with him. Also, if other surgeons follow his lead, this could change how many patients are approved for Lap Band surgery with insurance.

This is a big revelation, as UHC is known as being one of the most LapBand-friendly insurance companies (for those members whose employers did not specifically choose to exclude bariatric surgery coverage). It is also an insurance company that this surgeon, and many others, often encourage their patients to switch to - so they can increase their chances of insurance approval.

He will apparently now be "Out of Network" only UHC patients, and his office is saying that they can no longer accept the smaller payments that UHC is offering to their in-network physicians.

This means that patients will be asked to defray the difference in costs between what surgery/treatment/fills/visits would cost at In-Network rates (which is usually covered at rates of 80% to the rare but wonderful 100% coverage) for UHC patients to now an Out of Network rate of 55% - 65% to patients.

For example, one UHC patient has said that the cost of the surgery with Dr Spivak as an in- network physician would have been more than $5800 less out-of-pocket but now that Dr Spivak is Out of Network, the patient is responsible for paying that $5800 difference.

This is notable as Dr Spivak was one of the first LapBand surgeons in Texas, and usually leads other local surgeons in how Lap Banding issues are handled surgically and otherwise. In other words, if other local surgeons eventually follow his lead (it has happened before) then patients will have some significantly higher costs in store. (Dr Spivak and Dr Spiegel's Surgery Center is already Out of Network with United Health Care but those costs have always been detailed and explained up front.)

I am double-checking with some contacts I have from UHC (on the corporate end) to verify that the financial concerns for patients are correct.

Just an FYI.

(I will cross-post this on the Texas-related Message Forum, just to make sure everyone gets a chance to see this if they haven't already.)

Good Luck and Happy Band Journeys to all,

New Sho

ghb1324 · March 15, 2006

I think you have this backwards. UHC has dropped Spivak as an in network physician. I spoke with them today. They are working on this issue and are trying to make this work for his patients. He is going to charge me $2000 upfront and then see what can be worked out with insurance. If he can't get anything worked out the total cost is $5000. UHC was only wanting to pay $1100 for the procedure which of course is not nearly enough. Just thought I would clear up the fact that it's not Spivak that's dropping the insurance. It's UHC that's doing the dropping.

HeatherGurl · March 15, 2006

I think you have this backwards. UHC has dropped Spivak as an in network physician. I spoke with them today. They are working on this issue and are trying to make this work for his patients. He is going to charge me $2000 upfront and then see what can be worked out with insurance. If he can't get anything worked out the total cost is $5000. UHC was only wanting to pay $1100 for the procedure which of course is not nearly enough. Just thought I would clear up the fact that it's not Spivak that's dropping the insurance. It's UHC that's doing the dropping.

The girl I talked to at Spivak's had said that Spivak didn't want to deal with UHC because they were only wanting to give him $1100 and that isn't beneficiary to him or his patients. He is currently trying to work something out with UHC.

I think it is UHC's fault and I TRULY believe that Spivak is doing all he can to make it better for his patients.

ghb1324 · March 15, 2006

That kind of bothers me that they are giving two different stories. I am suppose to get my band on Monday, the 20th. When they called yesterday Brenda made it sound like it was UHC dropping Spivak. I'm concerned I'm getting scammed somehow. When I called the hospital to ask how much the procedure would cost they said they have worked out a deal with UHC so that UHC covers 90%, even though they are out of network. So why will UHC work with the hospital but not Spivak???? Doesn't that seem kind of strange?? Or am I just getting paranoid? I'm already nervous enough about getting this done but now I'm questioning if this is sign or something to not go through with it...Don't you love insurance???

Angels · March 15, 2006

Here in Maryland the entire cost for the procedure self pay is $14,000 and the surgeon only receives $5,000. What is the total cost and how much specifically does the surgeon get? Just curious. Thanks

Angels · March 15, 2006

Here in Maryland the entire cost for the procedure self pay is $14,000 and the surgeon only receives $5,000. What is the total cost and how much specifically does the surgeon get? Just curious. Thanks

getinsmlr · March 15, 2006

I must chime in on this. I have UHC insurance, and they are awesome for patients! My surgery cost me a total of $100. But last week I got my EOB from them for my Febuary surgery that Dr. Spivak performed. I was shocked to see that he was only paid $1065 out of $12,000 billed. The hospital was paid $6900 for $35,500 billed. I realize they have contractual agreements with UHC, but a doctor only getting $1065 for surgery seems very low to me. I don't blame Dr. Spivak for dropping them.

HeatherGurl · March 15, 2006

That kind of bothers me that they are giving two different stories. I am suppose to get my band on Monday, the 20th. When they called yesterday Brenda made it sound like it was UHC dropping Spivak. I'm concerned I'm getting scammed somehow. When I called the hospital to ask how much the procedure would cost they said they have worked out a deal with UHC so that UHC covers 90%, even though they are out of network. So why will UHC work with the hospital but not Spivak???? Doesn't that seem kind of strange?? Or am I just getting paranoid? I'm already nervous enough about getting this done but now I'm questioning if this is sign or something to not go through with it...Don't you love insurance???

If you are really worried, which understandably you are, you need to call and know 100% what you are expected to pay. Simple as that.

NewSho · March 21, 2006

I think you have this backwards. UHC has dropped Spivak as an in network physician. I spoke with them today. They are working on this issue and are trying to make this work for his patients.

Who is "they" - if it's UHC you speak of, then I'm afraid you misunderstood what you heard or were misinformed, I believe.

So I'm sorry to be blunt but, no it's YOU that have it backwards.

Number one - when I have a question about Network Status, I call an internal number or someone who has contacts in Provider Relations at UHC.

Number two - I was clear on my information before I posted - and I did not base it on one phone call with a random Customer Service rep.

Not to be snippy but a bit of research before stating your opinion (that's what that was) would probably be better.

He is going to charge me $2000 upfront and then see what can be worked out with insurance. If he can't get anything worked out the total cost is $5000. UHC was only wanting to pay $1100 for the procedure which of course is not nearly enough. Just thought I would clear up the fact that it's not Spivak that's dropping the insurance. It's UHC that's doing the dropping.

Hmmm... Uh OK. I guess that's better than you paying your In-Network rate for the same surgery. I understand that there is a HUGE issue with UHC changing it's reimbursement rate for docs, but you're still wrong on what's happening here.

And then to the later post

That kind of bothers me that they are giving two different stories. I am suppose to get my band on Monday, the 20th. When they called yesterday Brenda made it sound like it was UHC dropping Spivak. I'm concerned I'm getting scammed somehow.

I can't say that anyone is scamming you - but there is something uncomfortable about all of this. I wish we all had more answers, but what I do know is that's it's important to get clear information and not just hear-say.

When I called the hospital to ask how much the procedure would cost they said they have worked out a deal with UHC so that UHC covers 90%, even though they are out of network.

You didn't mention what facility it is. But each and every facility has a different rate that they get from UHC, based on how their facility rate is contracted. They all vary.

So why will UHC work with the hospital but not Spivak???? Doesn't that seem kind of strange?? Or am I just getting paranoid? I'm already nervous enough about getting this done but now I'm questioning if this is sign or something to not go through with it...Don't you love insurance???

Love 'em? Usually not. But most of the time, insurance companies provide a much-needed service. It's just they do it at the highest rate of profit that they can muster. Health Care is in sorry shape in this country. But honestly there had to be a better way of approaching this for all of the parties involved. Facility vs Surgeon vs Insurance companies = it's the patients caught in the middle. And it truly bites!

Happy Band Journeys to all...