Additional Cost Not Covered by Insurance

[IndioGirl55 32]

Question - I just made my 1st appointment for consulation for the lap band surgery - The person at the Doctors office (Dr. Bobbie - Palm Springs) Once i get approved and come in for my pre-op visit that 2 weeks prior to the surgery there is a $6,000 fee the doctor charges for things not covered by insurance

Such as 2 weeks prior he puts you on a liquid diet he supplies the shakes, stupid stuff like a pedometer, food draiy etc - and this includes fills for 5 yr. She just gave me a few of the items - they will give a list when i come in - so with my co-pay that's $9600 bucks - that sort of seems like a rip off the $6,000 for future services. Why wouldn't Doctor Visits be covered by my insurance - why wouldn't fills be covered too since it part of the procedure...

Any one have any ideas.....

[musicalmomma 1]

Sounds to me like a big rip off too...I think I'd be looking for another surgeon.

[Alexandra 55]

Many doctors have a "program fee" that is charged for the various things they provide that aren't covered at all by insurance. Things like support groups, supplements, extra tests or publications, all of these can add up and it's the rare practice that supplies them all just for the cost of the medical procedures. So in principle there's nothing wrong with it.

But that does sound like a lot of money for incidentals. Fills for five years, though, is GREAT and might be worth paying for that up front since many carriers only cover limited fills (on a schedule, say, or only a limited number or for a limited period of time). All in all, if the doctor can guarantee that this would be the only money you'd be shelling out it might end up being a good value.

Another surgeon's office might not provide the various levels of support this one does, and you might be left in the cold or finding that you have to pay for one thing after another. So it's something to consider.

[IndioGirl55 32]

My problem is he is the only doctor here in the Desert - My concern in going out of town is for the follow up care - and in case something goes wrong - i don't want to have to drive 3 hrs to see a doctor.

[Lisa H 0]

Hi Alexandra, I always like to read your posts-they're very insightful for me. I see that your band slipped after almost four years. How did you know there was a problem, and do you know what caused it? I start my pre-op diet tomorrow, and will be banded on June 1st. I have a hiatal hernia, and have heard that it can cause a band to slip. Needless to say, I'm pretty worried about that. Also, did you get to a point that your band had the right amount of saline, or do you still have to go back for fills periodically for life? Thanks for any info you can give me!

Lisa

[Alexandra 55]

Totally understandable. Well, in that case you may just have to suck it up and pay it. It's not a totally unreasonable amount for five years of unlimited aftercare with fills. $1200/year is what it amounts to, and if you get six or eight fills (under fluoro? Does it cover the fluoro?) and see the doctor a dozen times over five years it starts to make a little more sense. It does cover you no matter how much attention you will need, right? Make sure of that. If you're paying a premium price for access to a local doctor, you want to be very sure you get the ACCESS you want.

[Alexandra 55]

Hi Lisa,

I'm going to copy your post into a thread about my rebanding, and answer you there. Just so we don't hijack this thread. Follow this link to the thread about it.

[IndioGirl55 32]

Another dumb question - what is fluro??? I am a newbie - i don't know all the terminalogy yet. :0)

[Alexandra 55]

Fluoroscopy is an x-ray that shows moving images, like an x-ray movie camera. That's the way a lot of surgeons do their fills, so they can see exactly what the effect is of adding a particular amount of Fluid to the band. It's a very precise tool, but not all doctors do it that way. It adds to the cost of a fill quite substantially, since it's done in a hospital or radiology suite.

[IndioGirl55 32]

Thanks - now i know - another question are fills covered by insurance

[Alexandra 55]

Fills should be covered by insurance, if it covered the banding in the first place, because they are an integral part of the treatment. But you'd have to check with your insurer to see if there are limits or conditions on the coverage.