PROGRAM FEES

[Pookeyism 1,143]

Get it itemized. Check with other doctors to see if costs balance. My guy was a bit more pricey but it was an almost totaly up-front cost if I were to have only had the sleeve.

also - save every reciept, every DIME you spend in travel, etc. this is surgery. Out of pocket can reduce the taxes you pay this year.

[K9chita 14]

I have just started this process. I had my initial meeting with the doctor on Tueday.. I had a co-pay, but no other charges. The Nutrician/Dietician is $75 for the first vist, $40 for the next two months....as I have to show a three month supervised attempt with them. There is/was no $1000 fee though. My insurance cover on 85% of the cost, but I would assume I would pay that prior to the surgery.

[tigerbelle 328]

I understand a lot of the concerns about high deductibles and out-of-pocket charges...but I just want to remind some of you that you are fortunate your insurance covers the surgery...mine does not, and it is a major issue with me--mainly because I am a state government employee covered under our state's overall plan...Medicare and Medicaid cover WLS, but our state insurance does not--talk about inequity...well my usual rant about this is over, but to put things in perspective, at least a lot of you did not have to pay $15,000 like I did

[Brighteyes 237]

I understand a lot of the concerns about high deductibles and out-of-pocket charges...but I just want to remind some of you that you are fortunate your insurance covers the surgery...mine does not' date=' and it is a major issue with me--mainly because I am a state government employee covered under our state's overall plan...Medicare and Medicaid cover WLS, but our state insurance does not--talk about inequity...well my usual rant about this is over, but to put things in perspective, at least a lot of you did not have to pay 15,000 like I did[/quote']

I don't think the original poster was complaining about the charges. I think the frustration was with not understanding/knowing what all the charges were up front. Regardless if its a $100 or $15,000 you still need to be able to budget out for those expenses. Just my thoughts....

[smckean 2]

Where I go we have to pay a $300 fee for the program. We meet with a nurse, dietician and therapist on the same day and then have lifetime access to them. This is even before we know if insurance approved us or not. That's the part I done like. They say this is so they can evaluate readiness and provide education but I disagree. I was only there 2 hours - 20 minutes with a therapist. That's not enough time. . At this stage I've already gotten physician support and seen the surgeon who is on board. I can't believe your group wants a $1000.

[tigerbelle 328]

I don't think the original poster was complaining about the charges. I think the frustration was with not understanding/knowing what all the charges were up front. Regardless if its a $100 or $15,000 you still need to be able to budget out for those expenses. Just my thoughts....

oh, I know, and I didn't mean to really be addressing the OP...it was some of the others who had responded and taken the opportunity to complain about their own high deductibles and extras...you are right--as to the OP's first post, and I did reply with a question about what the $1,000 fee was for...regardless of self-pay v. insurance, everyone has the right to know what fees are being charged and for what purpose...and the fees should be reasonable regardless of self-pay v. insurance....I hope the OP finds out what that $1,000 fee is for

[Rozz76 7]

I paid $225 for a psych eval and a $30 office visit. No program fees were charged and since my psych eval was out of pocket, it went towards my $250 deductible.

[m4huskers 10]

My doctor's office charges $200.00 when you make the appt for the surgery. That fee is to cover support groups, dietary & exercise support, etc for life - the stuff that insurance doesn't cover.

[new_me_2013 46]

Seems very strange...everything I did was submitted to insurance, my seminar & nutrition classes were provided free of charges. There are several programs in my town & none of them

Charged anything like that.

[danaevett 179]

I emailed my surgeon's office and asked for an explanation of the Program Fees. Below is their answer. Excuse the fonts. That's just the way they came out when I cut & pasted.

Our program fee is an administrative fee which helps to offset the

practice's cost of services we provide patients, in our comprehensive

program that are not covered by insurance. Because this is an

administrative fee and covers services that are non-billable to insurance

it is an out-of -pocket expense and does not include or get applied

toward your deductible, surgical fees, or co-pays.

It helps us cover expenses for the EMMI program (the online computer

educational service available to you and support persons both before

and after service), our pre-operative educational class, educational

materials, nutritional teaching supplies, support group expenses,

informational sessions, after-hours call support, etc.

All patients who wish to participate in our surgical program are charged

a program fee. lf you are a cash pay patient, this charge is already

included in your total cost of surgery.

We strive to offer our patients the best and most comprehensive

program in the area. Program fees are a part of most bariatric

programs and we strive to maintain a competitive program fee in order

to keep your costs reasonable while giving the best care we can.

[m4huskers 10]

I emailed my surgeon's office and asked for an explanation of the Program Fees. Below is their answer. Excuse the fonts. That's just the way they came out when I cut & pasted.

Our program fee is an administrative fee which helps to offset the

practice's cost of services we provide patients' date=' in our comprehensive

program that are not covered by insurance. Because this is an

administrative fee and covers services that are non-billable to insurance

it is an out-of -pocket expense and does not include or get applied

toward your deductible, surgical fees, or co-pays.

It helps us cover expenses for the EMMI program (the online computer

educational service available to you and support persons both before

and after service), our pre-operative educational class, educational

materials, nutritional teaching supplies, support group expenses,

informational sessions, after-hours call support, etc.

All patients who wish to participate in our surgical program are charged

a program fee. lf you are a cash pay patient, this charge is already

included in your total cost of surgery.

We strive to offer our patients the best and most comprehensive

program in the area. Program fees are a part of most bariatric

programs and we strive to maintain a competitive program fee in order

to keep your costs reasonable while giving the best care we can.[/quote']

This basically what mine is - its lifetime. I really don't have a problem with it especially if it helps keep me healthy the rest of my life.

[rensterness85 71]

I had a $50.00 seminar fee and that was it. It varies on your insurance, but you should get a letter from your insurance stating what part you are responsible for...doesn't add up, but who knows. I would def look into it more.

[Mkak 251]

While I don't think they are being fraudulent, I do think they are bending the insurance rules a bit. Generally, a provider is not permitted to bill you outside of what the insurance company pays (assuming they are in-network). It looks like they are considering the extra services as outside of the normal care requirements. In a perfect world I would liked to have seen that $1,000 built into your office visit charge, consult charge, surgical charge, etc.

What is most likely is going on? They have gotten squeezed by your insurance company (most likely for a few years) to slash their fee and need to make that money up somewhere. The best example of this is to check out your explanation of benefits. 95% of the time the amount the insurance company pays is in excess of 50-60% less than what your doctor submitted as the billed charge.

If you like the surgeon and think you will use the services, I would say just bite the bullet and pay the $1K. If you're not sold on him/her, can't hurt to look around a bit more.

Best of luck to you!

[nyorker 67]

300 bux when i was approved. For nutritionist for a year and unlimited meetings with group and 90 days with Dr no copay. I dont go to meetings. I dont really need support. Psychologist wanted $200 deductable but i complained and paid nothing i sent them the 19 bux my insurance sent me for out of network. Hospital probably will be 300 bux deductable.

Surgeon got paid 1775 from insurance ( so cheap ) and hospital bill is 66k but dont know how much they got yet. So out of pocket for me so far is 300bux and maybe another 300 for hospital deductable.

[m4huskers 10]

I think what is considered "Not medically necessary" which is what Program Fees are is not going to be billed to insurance for that reason - it's not medically necessary so it's not going to be applied to your insurance deductible or coinsurance (out of pocket) either. That is why it is billed as a program fee or administrative fee whatever you want to call it.