What this program fee about?

[mskutz 0]

Hi all....I am a newbie to the forum and I attended my intro seminar yesterday. The surgeon, Dr. Liao from GBMC in baltimore explained that you have to pay a $500.00 program fee before your information can be submitted to the insurance company for approval. Has anyone else had to pay a fee like this?

Moreover, has anyone had surgery at GBMC with Dr. Liao or Dr. Mo?

Also, does anyone have BlueCross/Blue Shield. If so can you explain the insurance requirements? And if they have a 3mo or 6mo suprevised weight lost requirment?

[Sistabigbones 0]

Hi! I know things can be frustrating just getting started. I am not sure about the "program fee". I do also have blue cross but mine is blue cross blue shield of ga for whom i work for. Each employer group determines the benefits that they will offer for their employee.. To say that, i mean, u may have blue cross blue shield of ga too but work for let's say the bank. You may not have ANY coverage for WLS because your employer decided not to cover it. But with that being said, blue cross blue shield of ga does not require a 3 month diet. BMI <40 needs comorbid conditions bmi >40 needs no comorbids..will have to do a psych eval, nutritionists appt,medical clearance and some drs want pulmonary and cardiac clearance. Call your customer service number on the back of your card, they can tell you exactly what you need and in most cases, will even mail an intro packet to you related to your weigt loss surgery ie: deductibles,copays,etc.. Hope that helps....

[vonhelzing 3]

Hi,

I have BC/BS of IL. I had all the requirements of the previous post plus 6 months with a nutrisionist and 5 years of documentation of being overweight. I don't know about the fee, my surgeon did not have one. I don't think it cost's $500 to submit paperwork that mostly you will have to collect yourself.

[lindas0809 0]

The program fee is something that some hospital programs require and some don't. I live in the Baltimore area and checked out a lot of programs- both GBMC and St Agnes require a $500 fee that cover a lot of the their pre op requirements. One reason I chose Johns Hopkins Bayview was that they did not require a program fee- all my preliminary appointments(nutrition,psych eval)were covered by my insurance. I was banded last week on the 5th and had a great experience at Bayview. Please feel free to send me a private message if you have questions or want to talk.

Good luck!

Linda

Edited June 11, 2009 by lindas0809

[nazzy 1]

hey all,i had to pay 400.00 for classes after the surgery was over.the place is to far,so ive never gone to any of these classes.kinda makes me mad i had to pay for this when ive never used it,like i gave 400 a way for nothing

[IAmDoingItIn09 0]

Hi mslutz,

I would check with the doctors office on that. I am also in the process of trying to get approved and going through Sibley Weight Loss Center in Washington DC. They require a $600 program fee but with that you get, consultation, 4 visits with the nutritionist (1 post-op and 3 pre-op), 4 visits with the personal trainer (1 post-op and 3 pre-op), your psycological examination, a binder of information and I think thats it I may have left something out. I have noticed a lot of offices requiring a program fee now....some as high as $750(GWU) and not including anything. Good luck!!! What part of Maryland are you in...I'm in Laurel.

Back2Fab

[Katycando 0]

I checked several clinics around here (SE VA), and they all had fees (ranged from $495-$750). I think most surgeons want to make sure the surgery is as successful as possible, so they want to educate us. My surgeon, if I'm approved, requires two support group meetings, a "wellness"(read: fitness & nutrition) seminar, a book they wrote (3 ring binder w/ about 100 pages of info), a pre-surgery preparation seminar, and membership to the hospital fitness facility. Of course, these classes also meet insurance requirements. I guess bottom line is that the insurance company wants to make sure they aren't wasting their money, and surgeon doesn't want his liablity insurance going up!

[eyezchu22 6]

I have bcbs of Ma and they require pre authorization for wls and after that I have a $500 deductable I have to pay but the rest is covered. My program fee is $250...

[HolliJ 24]

The original surgeon I was looking into charges a $3,700 program fee - which is not covered in insurance. How ridiculous!

The surgeon I'll be going with has NO program/administrative fees at all! So I'm thrilled with that. There's no reason we should have to pay some extra out-of-pocket fee.

[SamB 0]

The doctor that I saw charges a $275 program fee. This is supposed to be for the nutrition classes, education materials, etc. that are provided. I have only had my initial consultation so far. I have BCBS federal and I was told by the doctor's office that they needed to send letter of med necessity, primary care phys clearance, thyroid blood test, phych eval, and nutrition consultation. I spoke to BCBS fed on the phone, and they did not mention the 6 mth diet/exercise requirement. I'm hoping to have everything finished and sent off to insurance by next week.

Good luck!

[kshannondc1 0]

I went to a information seminar at our local bariatric center and they want $2500 for a program fee. Yep, $2500 at the initial visit. If you don't have the money, you don't get an appt. I was very upset by this. I have been quite ill for almost 5 years now and am due in for a spinal tap next week because they think I may have too high CSF pressure which can be attributed to my weight. Since my illness, my weight has jumped sky high and this is very important for me. (as I'm sure as for all of you) So, this $2500 does not include shakes, or doctor's copays. From how it was described, it covers a required gym membership at the center, weekly support meetings with others like us, and 4 consults with their trainers. Oh, and in the packet was a form that said you have to see their psychiatrist too and of course must pay cash. Does this sound right to anyone? It felt more like extortion to me.

[HolliJ 24]

I went to a information seminar at our local bariatric center and they want $2500 for a program fee. Yep, $2500 at the initial visit. If you don't have the money, you don't get an appt. I was very upset by this. I have been quite ill for almost 5 years now and am due in for a spinal tap next week because they think I may have too high CSF pressure which can be attributed to my weight. Since my illness, my weight has jumped sky high and this is very important for me. (as I'm sure as for all of you) So, this $2500 does not include shakes, or doctor's copays. From how it was described, it covers a required gym membership at the center, weekly support meetings with others like us, and 4 consults with their trainers. Oh, and in the packet was a form that said you have to see their psychiatrist too and of course must pay cash. Does this sound right to anyone? It felt more like extortion to me.

Sounds like a bunch of greedy assholes to me!

[vonhelzing 3]

I would contact your insurance about program fees. It seems to me, that if they are covering the surgery, they would cover everything associated with it. I think the surgeons are looking for exta money. I only had my copay. I saw their nutrisionist and got all the literature and counsling with no cost to me.

[paisleypea 1]

I have found they are all different. My surgeon requires an initial consult with the nutritionist at $50 and then a 5-hour class with her that cost $150. I thought it was overkill when others didn't charge that, but.........then I found out it could have been a LOT worse and I really liked my surgeon. I figured if I was getting it covered by insurance, that was kind of like my "co-pay"

[mskutz 0]

thanks all! That helps so much! Im changing doctors!!! JHU Bayview dosen't have any program fees!!! I just have to start the program again...lol..."What dosent kill you will only make you stronger!!"""""