Can we say rip off ? Need others opinions, please

[BeachBish 123]

Upon attending seminar a number of times was told by DR. the cost for fills would be your co-pay. If you had insurance all you would have to pay would be the CO-PAY.

Quick synopsis:

Lap Band surgery 6/10/13.

after surgery all fills were done by nurse at participating weight loss center operated by hospital at a cost of $150 each fill/or unfill.

As of 5/1/14 they are closing that facility and now I am required to go to the Dr's office that preformed the surgery and the Dr. will do the fills at a cost of $400.00 for each fill or unfill.

Yes, I have insurance but the deductable and the major medical must be meet prior to any insurance paying as it is now filled with a "SURGERY" code.

I'm not sure if this is legal or ethical.

Maybe I should contact the Insurance commissioner ?!?!?!?!

How can they just up and decide to change mid stream???

The closest other Lap Band Dr. is 40 minutes away. Fills are $100.00. Should I go to another Dr.?

Can someone be so kind to kind as to enlighten me on cost of your fills/unfills.

#totallyaggravated

Thanks everyone!

Edited May 28, 2014 by BeachBish

[lisacaron 5,075]

You should call your insurance company and ask them what the charge should be for a fill/unfill from this Dr. if he is in your plan they should have a negotiated rate with him/her. If he is out of your network, then maybe you want to fine another doctor who is in your network and provide a better service for you at a more reasonable rate.

Either way your insurance provider should be able to help you to find one who is going to work with you and them to provide the service you need and do so at a good rate. There is also a place on this application where you can search for Dr.'s and Surgeons in your area. Then you can call and see if they accept your insurance. If you HAVE to pay out of pocket for each fill/unfill perhaps there is a way to work out a deal with the office of the Dr. of your choice for a certain number of fills/unfills at a certain out of pocket rate. Usually they are willing to work with cash paying patients at a lower rate vs. having to bill insurance companies.

Wishing you all the best!

[Anne Marie Elias 15]

My doctor had me sign a paper before surgery that stated after my 90 day bubble, fills will be $500 each visit. They told me several times that would be the cost. I am hoping I reach the Green Zone before my bubble is up.

[kimk1999 450]

I have a major medical type insurance and currently pay about $250 per dr visit w/fill. They charge first close to $500 but the insurance 'agreement' with them gives me a 'reduced' rate. I think I need a smidge more so I'll see my doc again, but it's getting expensive.

I hate insurance and doctors who charge too much but I really like my surgeon.

[catfish87 3,471]

I have BCBS insurance through my employer.

If I get an adjustment, my insurance gets billed $700, the negotiated rate is $486.25. They pay $389.00, and I "should" pay $97.25 ( after meeting my yearly insurance deductible I've got an 80/20 plan )

This include's the normal office visit and discussion with the SURGEON, and prob 15 min discussion with a NUT. AND ALWAYS Fluoroscopy guidance/viewing....wouldn't have it any other way.

Edited May 30, 2014 by catfish87

[BeachBish 123]

WOW! All of a sudden $400 seems to be on the low side.

Lisa, you are right...I will investigate further.

Yesterday I called Insurance Co BCBS with code; they were unable to tell me what the allowable amountwas?!? Stated the provider should tell me. Provider states they have no~clue until it is filed. ( WTH )

Anne Marie ~ I myself am beginning to wonder about the GREEN zone and when I will get there....So far either to tight or not tight enough.

Kimk - I THINK that's the way my will pan out as well; however it would be nice to know up front.

Catfish - $700???? Surely THAT WAS A TYPO ? Thanks for including a breakdown and copy of your billing. Actually that sounds reasonable once it is processed.

HAHA Funny stuff on your "NUT" visits
what is the fluoroscopy

Maybe the same as saline??

Thanks everyone for your responses. Have a GREAT weekend!

[catfish87 3,471]

Catfish, What is Fluoroscopy?

Fluoroscopy is when they use what I refer to as similar to a live X-Ray during the adjustment.

It can be helpful for locating some peoples port. But the main reason is to physically SEE placement of the band, and how much restriction a person has, and that all is well. You drink a contrast Fluid and the surgeon and you can SEE how fast or slow the barium Fluid passes through the band area. In my opinion, due to my experience, ALL doctors should be using this method, at least occasionally. It can show other things besides restriction levels....

Here's a link to my surgeons page describing it.

http://www.hoab.org/fluoroscopy-st-louis-missouri/

Heres a video of my band from last year.

Edited May 30, 2014 by catfish87