Anyone Out There?!?

[phenry 0]

I guess I will find out if there are any upfront fees once I get started after my seminar. I just don't get why you have to pay upfront money if it is covered by insurance. I am going to consult with my insurance company to see if I can avoid all that if it comes down to it. I wouldn't mind so much if I knew I would be reimbursed....but still...if it's a covered service...why pay upfront. Guess I will find out sooner or later!

[JayTee562 1]

That one place called RightWeigh or whatever...they say NO upfront charges...just what the insurance will pay is what they will take. But they don't mention their surgeons on their webpage. Makes me wonder if they are like a band factory where you lie on a conveyor belt and go through the banding process like branding cattle. I don't want to go to a place where I don't feel safe! Any opinions?

I can't find it right now but somone on here said it's Dr Mark Shina and then one time I saw his name on their site. His office in in Jeffersonville and he also comes to Suburban. The day I was looking at their site they said that surgery can be done at a hospital on that side of the river.

Dr. Shina is who I'm seeing, I liked him on initial consult and will be sticking with him if I have the surgery. I'm going through Norton and have to pay $300 when I go to Norton Bariatrics neat thing about Dr Shina is he did the consultation before I had to pay the money he's I think he's the only Dr. at Norton that does that. My PCP Refered me to him.

[phenry 0]

Yes...I found out yesterday that it is Mark Shina. He has a good reputation from all I have read. I am scheduled for a consult on the 13th of this month. I really like the idea you get to see and talk to the doctor without upfront fees! He does seem to be the only one doing that in this area.

[JayTee562 1]

He's very frank and up front. Are you going through the seminar and consult thing they do? That's how my first appointment was when they say give it 4 hours they mean it. We arrived at 9am and I walked out a little before 1pm. If you google his name there a site with reviews Good Luck

[phenry 0]

Wow! 4 hours? I am glad you told me. They called yesterday and set me up for next week. I have asked my husband to come home from work early to watch the kids. I am supposed to receive a packet in the mail with information.

[JayTee562 1]

If it's seminar and consultation at the same time it took that long when I was there. About 8 of us were there some of us took someone with us some didn't. They looked over our paperwork and asked for anything that was missing. Then we got called in individually photographed, weighed, the person asked a few questions then we were free to go till the seminar. Dr. Shina did the seminar and then we went each ahd about a 5 minute consult with him. He asked me a couple questions looked at my legs for Water retention and looked over my meds gave me status of which I'd need chagned befroe surgery and I was on my way...4 hours later.

If you are not seminar and consult on the same day then it may not be as long.

[denibun 0]

Since you have anthem, it will cost you nothing but your copays. Any other insurance and they require $4000 up front, but not with anthem. They're a great group. I have had no complaints with them at all.

[JayTee562 1]

I am scheduled for a consult on the 13th of this month.

How did everything go?

[samiott 0]

I am going through St. Mary's program as well. I thought you had to pay the $4k upfront on your second visit with the doctor. I have already paid the $100 and I believe I have to pay the $4,000 next visit and then get my insurance to pay me. I may be wrong here but that is what I thought.

Did they require you to pay the $4000 upfront or did they send it to the insurance first?

[KyBandChick 3]

Did they require you to pay the $4000 upfront or did they send it to the insurance first?

I did have to pay the $3,900 on the visit the days before my surgery. My insurance then sent me a check for the portion they covered. My insurance was not one of their "approved" plans so they made me pay up front.

[samiott 0]

I did have to pay the $3,900 on the visit the days before my surgery. My insurance then sent me a check for the portion they covered. My insurance was not one of their "approved" plans so they made me pay up front.

Hmmm...so if the insurance is "in network" now (UHC just became "in network" on Dec. 1, 2009 at St. Marys and Elizabeth)... then maybe now I won't have to pay upfront?... I guess I will have to call and ask them on Monday...

[hollynn 0]

It is the doctor's that are out-of-network. That is why they are allowed to charge whatever they want. The hospital is still in network. this way the doctor's guarantee they get $4000 for the surgery which is crazy because I know the usual reimbursement from insurance is around $1000. Call you insurance and ask about cpt 43770. you shouldnt have to pay anything above your copays and deductable.

I am seeing Dr. Geller, who is also in the Norton's bariatric program. For the Norton's program, there is a $300 program fee to see the nutritionist and psych doctor before surgery. But the surgeon doesn't have any fees. I know that Dr. Geller accepts the insurance allowable as payment in full. I don't know how the St. Mary's docs get away with what they do. They definitely aren't better.

Holly

[KyBandChick 3]

Hmmm...so if the insurance is "in network" now (UHC just became "in network" on Dec. 1, 2009 at St. Marys and Elizabeth)... then maybe now I won't have to pay upfront?... I guess I will have to call and ask them on Monday...

Certainly call and ask but they were very good at warning me when I needed to bring money. If they say your insurance is in network then you probably wouldn't have to pay or would pay a lower amount. At the time of my surgery they said then Humana was their only in network even though my insurance paid me as if they were in network.

[KyBandChick 3]

It is the doctor's that are out-of-network. That is why they are allowed to charge whatever they want. The hospital is still in network. this way the doctor's guarantee they get $4000 for the surgery which is crazy because I know the usual reimbursement from insurance is around $1000. Call you insurance and ask about cpt 43770. you shouldnt have to pay anything above your copays and deductable.

I am seeing Dr. Geller, who is also in the Norton's bariatric program. For the Norton's program, there is a $300 program fee to see the nutritionist and psych doctor before surgery. But the surgeon doesn't have any fees. I know that Dr. Geller accepts the insurance allowable as payment in full. I don't know how the St. Mary's docs get away with what they do. They definitely aren't better.

Holly

You are correct in saying the reason for the 4k charge that they charge you up front so they get the full $4k and not the insurance contractible rate which will be much less. How are fill charges in the Norton program? It's been a year since my surgery so I don't remember everything from the Norton meeting vs. St. Mary but I thought you had to pay for fills later with Norton where your fills are covered with St. Mary as long as they are your alloted fills. I haven't had to pay a dime to the doctor since I paid the $3,900 (and my insurance didn't pay me the full $3,900 back). The people who really get screwed are those without insurance since they don't get the insurance contract rate for the hospital either and have to pay a bunch for fills.

[samiott 0]

You are correct in saying the reason for the 4k charge that they charge you up front so they get the full $4k and not the insurance contractible rate which will be much less. How are fill charges in the Norton program? It's been a year since my surgery so I don't remember everything from the Norton meeting vs. St. Mary but I thought you had to pay for fills later with Norton where your fills are covered with St. Mary as long as they are your alloted fills. I haven't had to pay a dime to the doctor since I paid the $3,900 (and my insurance didn't pay me the full $3,900 back). The people who really get screwed are those without insurance since they don't get the insurance contract rate for the hospital either and have to pay a bunch for fills.

I'm just hoping there is little out of pocket expense. My husband is paying for my surgery and it was tough getting him to agree to let me get it done.

He's seen me struggle with my weight but he is naturally slim and a regular jogger so it's hard for him to understand my weight struggle. He's one of those guys that thinks he has all the answers to my problems. So the less I have to bother him about the surgery the better.