Odd response from my potential doctor

[trekker954 421]

After much research I emailed a bariatric surgeon I am interested in having do the sleeve procedure. He called me and we had a nice conversation, he told me a lot about himself which I already researched. Said I sound like a good candidate, Healthwise and all. So I said, you work with Federal Blue Cross blue shied. He said yes, but you should consider self pay. Now I'm pretty sure I meet all the requirements BMI 40 (occasional can drop to 39), have documented numerous doctor supervised weight loss programs on/off over the past five years,(two doctor supervised the past two years alone) as well as documented weight watchers, jenny craig, and others. I believe that is one check that many insurance companies want you on a supervised program for a few months. But if I can prove to check that box why would I have to do that all over again. Anyway, this doctor said insurance companies, want you on weight loss programs, psychologist reviews, nutritionist meetings, blood work, and so on. He said, why don't I pay the $12,000 up front and submit to get reimbursed rather than wait for approval. HUH? I wasn't born yesterday. he isn't making sense.

will blue cross really make me go thru much of this downtime, when I can prove I've been there; done that. And I would certainly hope he would run blood work, ekg and all that other stuff typically done before any surgery whether covered or not. And it will be.

I was a bit disappointed. I told him I would give my insurance a preliminary call and get back to him.

BTW, this doctor who has the words Lapband in his official business name (I think that is why it took so long for my to cross his path) said that some association (forgot if it was AMA) is no long endorsing lapband surgery. More bad than good coming from that. This conversation took place when I said I was only interested in the sleeve. He said he had done 10 sleeves just this week.

[zonetracy 53]

Sounds weird to me. I myself might be looking for a different surgeon. If he accepts your insurance that should be the way for you to go and pay your out of pocket maximum, not some $12,000. Also, check with your insurance about the doctor supervised weight loss classes they may accept them if they were recent.

[SleeveandRNYchica 1,155]

I would find another dr. Fepblue paid a great portion of my sleeve minute the copays. Weird he would say that.

[Sharon1964 2,530]

He's attempting to have you do this as if he was out of network, which makes me wonder if he really IS out of network. If he is not out of network, he would be violating his contract with what he is telling you.

If he is out of network, then he can ask for full payment up front, give you the claim forms and the op report, and have you file your own claim with the insurance company. It would be subject to the terms of out of network procedures, which can be really bad, depending on your plan. If they deny the reimbursement, it would be up to you to fight it.

It sounds to me like he wants to avoid the trouble of complying with your insurance and getting an authorization. For non-emergency surgery, you would probably still have to jump through the hoops or risk having everything denied.

I would find another doctor.

[kmd0235 38]

Find another doctor. I think his request is absurd.

[amazon 579]

Serious red flags...please keep looking. You will be going through enough, you don't need insurance and maybe unscrupulous surgeon headaches to boot!

[trekker954 421]

Thanks. He is listed in my bcbs network. Why would I pay 12k when there is a good chance all I have to do is a Co pay. Oh, his first question was if I had any previous "belly" surgery. Ugh, he is only about 2 miles away. I will keep looking. I had even signed up for fep bcbs online wellness program. Hopefully they will acknowledge my lifelong attempts.

[amazon 579]

Thanks. He is listed in my bcbs network. Why would I pay 12k when there is a good chance all I have to do is a Co pay. Oh, his first question was if I had any previous "belly" surgery. Ugh, he is only about 2 miles away. I will keep looking. I had even signed up for fep bcbs online wellness program. Hopefully they will acknowledge my lifelong attempts.

Do they require that you go to a Center or Excellence? Mine did, and I have BCBS.

[trekker954 421]

Thanks. He is listed in my bcbs network. Why would I pay 12k when there is a good chance all I have to do is a Co pay. Oh, his first question was if I had any previous "belly" surgery. Ugh, he is only about 2 miles away. I will keep looking. I had even signed up for fep bcbs online wellness program. Hopefully they will acknowledge my lifelong attempts.

Do they require that you go to a Center or Excellence? Mine did, and I have BCBS.

You are correct, they do indeed.

[Jersrose43 837]

You can report him to bcbs and he will be evicted from the network. He just violated his contract.

[The Candidate 3,215]

I agree that conversation sounded a bit sketchy to me too.

[Nora82 11]

I am an insurance coordinator for the surgeon who did my sleeve. Federal BCBS definitely takes past records. Anything within the last 2 years counts for supervised weight loss. We just got one approved in December with federal BCBS with past medical records.