Re: Dr Spivak in Houston...New Hope I Need you

[Guest FatNHappy]

Has anyone had to pay out of pocket to a foreign surgical assistant when insurance covers this? This seems strange to me

[New Hope 37]

What were you expecting to pay for your banding surgery? Houston is a multi-cultural city. There are many doctors from all over the world here. Dr. Spivak is from Israel and trained in Europe. Dr. Spivak gave you an info. sheet showing Dr. Beltran as Texas licensed. Why don't you ask Dr. Spivak directly before posting unproven facts 3 different times within 5 minutes?

[Guest FatNHappy]

It was Dr. Spivaks assistant who told me he was not licennsed. I am not spreading rumors, give me a break please

[Guest FatNHappy]

What was I expecting to pay? With 2 insurance policies I should only have to pay copays and that is what both policies tell me. I've never paid any doctor a large amount directly to him or any other doctor prior to surgery, my whole life. I even had another surgical [procedure performed on me many years ago and I had two practicing licensed orthopedic doctors working on me at the same time. That made me feel I was really getting the best of care. I feeel sorry for people that have to pay. But seriously, with 2 policies you should not have to pay.

Personally I really liked Spivak. I am single and have trouble paying my bills and paying $500 out of pocket to Beltran would take up my car payment money and I can't do that. Sure, if I had the extra it would be different.

New Hope, I believe you can't judge others until you walk in their shoes. I always want the best care I can get with insurance paying the whole bill. That's what I pay premiums for. Who wouldn't? It may sound petty to people who self pay, but $500 to me might as wel me $3,000. I am all alone in this struggle.

[Marimaru 7]

Hey-

Have you talked to Dr. Spivak about this directly? Or is he the one that told you you'd need to pay this? I can't imagine paying money to someone 'extra'... especially if they told you they are unlicensed... Double check the facts and see what they are...

If it's still the case you may consider asking your insurance(s) if they can recommend another doctor. I was self pay, but I didn't have to pay my doctor's assistants anything extra beyond the fee..

[New Hope 37]

I have 2 policies also. But one doesn't cover the band. It would have paid on my gallbladder and hospitalization. But I'd had to pay another $250 deductible to the hospital upfront. Yes, you would think 2 policies would cover 100%, but it doesn't work that way. I'm in the process of dropping one policy. I'm double paying (premiums) for something that they're not going to pay.. I'm certainly not judging you! I'm just concerned that you posted 3 times in 5 minutes about the same thing. Feel free to pm me anytime. What was the name of the person you spoke to in Spivak's office? I was told the reason for paying the assistant is because insurance is taking 6 months to pay him. Best of luck to you on what ever decision you make!

[New Hope 37]

A self-pay patient is in a whole different ballgame from a patient w/ insurance. All their fees will be included in the cash-pay price.

I'm sure there are other banding drs. available on your plan. You might check their protocol out. Good luck!

[New Hope 37]

I just spoke w/ Shirley (office manager) at Dr. Spivak's (713-520-8900). Dr. Beltran received his medical degree in Mexico. He is licensed here in Texas as a "Surgical Assistant". Insurance is taking over six months to pay him, so he asks for the $500 upfront from the patient, then fills the necessary paperwork. He also assists several other surgeons, besides Dr. Spivak. Hope this answers all your questions! Good luck!

[Guest FatNHappy]

Hope, it is amazing how one can hear different stories from the same office. I wish I had an explantion for this. Perhaps they meant to say he was not licensed as a surgeon, but that is not what they said. Shirley did tell me the same thing she told you. I have called them several times and I am not actually sure who said the different statement as I wasn't taking names down if you know what I mean, but it doesn't really matter who it was. I talked to UHC today and was told any doctor out of network is paid 60% for my policy and if it was life threatening surgery (which to me it is in my case with my blood pressure climbing sky high, and my doctor just put me on 2 more bp meds, so that totals 4 for me) then even out of network doctors are paid 100% and are paid within 7-10 days. They said the same thing applies for a Dr. assistant. So this makes no sense to me why your Dr Beltran bill has not been paid. Years ago I contacted the Texas Insurance Comission and insurance companies have to pay by a certain length of time, but that was many years ago. Maybe you can check with your UHC policy and see what they say. That would be extremely interesting. Don't ya just hate it when the same business gives different answers everytime one calls? This seems to be a reoccuring event in my life for years and you never know what to believe. They did say it had to be presented as "life threatening". I am retired and got Aetna with my retirement package so luckily I don't pay for it. UHC is with my present employer. I talked to UHC precertification today and they said pre certs take 10 days and if not approved in 10 days I can ask for expidite and that will only be 2 extra days. They said that the reason it can take longer is if the dr does not supply all the information they need. I am in a rush to get this done as my UHC ends Dec31 and then I will be with Cigna and no telling what will not be covered then. I may even decline the Cigna, not sure yet. Am I remembering correctly that your UHC took several months or 8 months or did I read that somewhere else? Do you know if Spivak is considered one of the best for this? He sure has his name listed on lots of entries on the internet to give that opinion, but then again I know lots of meta tags cando that too. I really did like him.

Do you know if Aeta pays for fills? I really appreciate your time and help. Almost "newbes" have lots of questions and concerns. I would pm you but have not learned how to do that yet on this site. Duhhhh....LOL

[New Hope 37]

Friends, O.K.? I'll be glad to help you with any thing that you need. I understand your time frame. Hopefully it will work out for you. Mine was denied in October 2003, appealed, banded May, 2004 (along w/the 3 other laproscopic surgeries). Those extras are not the norm for someone just receiving a lapband. So far I'm getting the same answers from everyone that I've contacted. It's apparently one of those "hurry up and wait" deals. No sense getting stressed out about it, that doesn't make them move any faster. If anything, I think they throw it in the back file. I'm not familiar with Aetna Insurance at all. Have you spoken w/someone in human resources (at your job)? They should be able to answer your ?? or direct you to the proper source. Get names, dates, time of conversations for future need. Do your research, so you won't get any unpleasant surprises. Best of luck to you!

Here's some contact info. for Dr. Oscar R. Beltran, L.S.A.

L.S.A. means Licensed Surgical Assistant

He has performed advanced laparoscpic procedures for the last 5 years.

His Office Manager is Gale 713-520-0658

United Surgical Assistants

1200 Binz, Suite 1275

Houston, TX 77004

713-520-0658