Question:
Has anyone else been told about the 4,500 program fee
Maybe this surgery is just not for me.(temporary moment of insanity - pls disregard previous statement) I just updated my profile stating that I was now going to just stick with Dr. Macik and wouldn't you know it. When I called the office they told me as of Jan 1, 2003 there will be a program fee of $4,500 due before surgery. You actully have to pay part of that before you are even approved. The fact that I am a not a new patient for them since I worked with them last year to get approval means absolutely nothing. What do I do know? Becuase I really dont have several thousands of dollars laying around. Vesta — vesta D. (posted on December 4, 2002)
December 3, 2002
My surgeon does not have a program fee but the Hospital does. It is
$2,500.00 and you have to pay $500 up front and payments for the rest. You
can not get into the hsp. without completing their program which this fee
covers. I really think it is a way for them to make up their costs that
the insurance doesn't cover. Talk to them, maybe they will take payments.
Good luck.
— Stacey F.
December 4, 2002
I HAVE NEVER HEARD OF A PROGRAM FEE. I WAS NEVER ASKED TO PAY ANYTHING
LIKE THAT.
— Linda A.
December 4, 2002
I know there are a lot of new programs, extra's being added , and the cost
up front is to help cover those things. One of the best additions is
having Dr. Teri on the staff there to help with all these issues that we
all go through....I'm sure they will be willing to help work out something
with you. Dr. Waits and Dr. Macik are the best, so hang with them !!!!
— Sandra T.
December 4, 2002
This is an outrage!!! Its the medical community's way of sucking out as
much money as possible for this very popular surgery! They are under
contract with many insurance companies which means they agree to only
charge a certain amount. This is their way around that! Those that charge
a "program fee" are in it for the money and not to save lives!
I'd look for another doctor immediately!!!
— thumpiez
December 4, 2002
Stuff like this really makes me mad. That #*&*&^ surgeon needs a
EMPTY waiting room. One they can hear the echoes in. To pevent other docs
from doing this have ALL patients notify them they are moving on. WLS is a
BUSINESS, and customers have clout. There must be some other good surgeons
in the area. If this jerk runs a support group meeting attend and hand out
flyers to organize a mass patient defection. This guy is only in it for
the money and obviously doesnt care about the patients he is putting at
risk. Put the complaint on the docs profile here. so newboies avoid him.
Let his office know he will get trashed here, this site has a power of
numbers. Rant mode off... Would others please suggest a NEW surgeon in her
area?
— bob-haller
December 4, 2002
Hi everyone, this is Vesta, I'm the original poster. And I appreciate
everyone's response but in all fairness I don't think the Dr is a quack or
anything. I guess I was just venting when I first got the news and maybe
came accross the wrong way. I can understand the program fee and yes, I
met Dr. Terri last year and she is great at what she does. I just wished
that if the fee is necessary that is just wasn't so high. Plus the fact all
the prelim work that they did for me July of this year should be factored
in (I guess in my mind it seemed like I've been going through this ordeal
for a year).
— vesta D.
December 4, 2002
The doc isnt a quack just a money hungry preying on the ill. Acceptance of
this fee will lead it to becomoing common pratice. Those affected would do
EVERYONE a great service by sending such greedy docs the message its
unacceptable by voting with their feet. Dr Schauer has mentioned those
surgeons in it only for the money. Now we know what he was talking about.
— bob-haller
December 4, 2002
If this fee were standard everwhere how many post ops wouldnt of been able
to have surgery?
— bob-haller
December 4, 2002
I had a $600 program fe which includes ALL of my post-op services including
the use of an excercise facility, an other outings with the group. I would
honestly look into other programs. This doctor seems outrageous. I did
however expect a hospital fee of that price and it wasn't even a third of
that when the time came. Good Luck on your journey!
— Lisa M.
December 4, 2002
Bob Haller....I would appreciate it if you didn't trash my surgeons. You
do not know all the information about why this is being implemented and
neither do I. I know for a fact my surgeons are one of the only ones in
the metro Atlanta area to hold a monthly support group meeting, which is so
important post-op. It's fine to have a opinion on this subject, but don't
trash doctors that you don't know and don't have dealings with. There are
reasons all the docs are different and do different things in their
practices. I'm very happy with them, and highly encourage anyone in the
Atlanta area to use them, they DO CARE !!!!!
— Sandra T.
December 4, 2002
$4,500 for a program fee is ridiculous and your surgeon deserves to be
trashed for it, Sandra. To require part of that (presumably
non-refundable) before you are approved is even more ridiculous.
<p>
The Hospital of the University of Pennsylvania runs *two* monthly support
group meetings - one for all patients and one for post-ops 7 months or more
out - and the maximum that gets charged is a $5 fee. And those patients
that have gotten their nutritional consult in a group setting (instituted
in June 2002) do not have to pay *any* fee for the support group.
<p>
I would like to hear exactly what this program fee entails. It seems to me,
like most other repliers, that this group is in it for the money...JR
— John Rushton
December 4, 2002
Aloha Vesta! Wow! Stirred up a hornets nest huh? lol Hang in there hon!! I
had a long (3 year wait after approval) to have my surgery because one
surgeon died, the other moved, third one had a long list and the fourth was
a charm.. BUT while I was waiting, I did come across two surgeons who do
charge program fees. Substantial ones like the one you are talking about.
When I asked them what it was for, both explained it to me like this:
Insurance companies pay minimal reimbursement for the surgery. If the
provider doesnt sign a contract with my particular insurance carrier, they
get even LESS of a reimbursement. One surgeon said that after all is said
and done, he gets about $2200 to perform the surgery, which as we know is
not a lot of money. He performs Lap so the cost of the equipment is a bit
more than an open procedure..but he doesn't see any of that. My insurance
carrier also requires that a surgeon perform follow up care but they don't
seem to pay for it. SO the program fee included ongoing lifetime
nutritional counseling, ongoing life time follow up care, exercise
training, lifetime support group meetings, behavioral psychology services,
etc. If you stop and think about it, it is not that bad of a deal. The HARD
part is coming up with the money... I ended up going with another surgeon
who didn't charge a fee because he is a military surgeon and everything is
covered. I think another poster hit it on the head. It is easy for us as
patients to make judgements on why a doctor charges program fee but if we
ask the questions, they will usually tell us. The days of the doctors
making a TON of money are really gone. Insurance companies do not pay for a
lot of the services that are rendered and if they do, it is just pennies on
the dollar. I wish you luck and hope that you are able to have the surgery
done because it is a Godsend. Had I not been able to go with my surgeon, I
would have gone with the one with the Program fee. I figure my life is
worth it. Hang in there! Hugs, Kathie (in Hawaii)..... Open RNY / 08-07-02
Down 98 Pounds!!
— KathieInHawaii
December 4, 2002
I agree, they should be trashed. My total out of pocket for my entire
surgery was only a $250.00 co-pay to the hospital. my surgeon didn't ask
for anything else. Sounds like a blatant profiteer. I don't think that we
are really trashing the surgeon,as much as his highly unusual and and
particularly expensive practice. I have never heard of this practice before
and I, myself, would find another surgeon. Just my $.02 worth.
— dkinson
December 4, 2002
You can turn them into your insurance company for breech of contract. If
they have a contract with a particular insurance carrier as a participating
provider then by them signing that contract they agree to ALL the terms,
conditions and PAYMENTS of the insurance carrier. Therefore, they are NOT
ALLOWED to ask for any additional monies from the patient/member above what
they get reimbursed for by the insurance company. I know I am a license
insurance agent. The first surgeon I went to tried to do this very same
thing. He pulled the "Well, the insurance company doesn't pay me
enough to do this" crap with me and I let them know that he was in
violation of his contract. If they don't like the reimbursement fees they
don't have to sign up with that insurance company.
By the way, that Dr. changed is tuned real fast once he realized I had a
clue to what he was doing.
Call your insurance company and ask them if the Dr. can do that or not.
I'll bet you'll be surprised by what they say!
— Lori F.
December 4, 2002
I have a $600 program fee with my surgeon. The $4500 seems kind of
execessive. I would talk with the office and find out exactly what it
covers. Mine covers alot of things that would cost me far more than $600
if I had to obtain the services on my own. It covers support group
meetings that offer far more than the standard sit around and chat
scenario, the dietary consult, ongoing dietary counseling, an excercise
physiologist and a bi-monthly newsletter. Also the majority of surgeons
doing this surgery are supported by a university or the hospital and do
other surgeries than WLS. Many have chosen to have a private practice that
offers services in-house that you would usually have to seek on the
outside. I can tell you that the care I will recieve from my surgeon with
the program fee will be far better than what I was getting from another
surgeon where I would have only paid the $100 co-pay.
I would check on what you are getting for the money before you pass
judgement.
— Chris B.
December 4, 2002
Sounds like a bunch of hooey to me!! Someone is taking advantage of
people!! Get another surgeon if you can honey, I would not trust this one
with my body. I switched a year in to another surgeon and it went very
quick because I had everything done already!!
— smedley200
December 4, 2002
As Chris B says, a program fee is not for the surgery, it is for all of the
support services some provide. These fees are usually around 600. My
surgeon has therapists, nutritionists and even clergy available at check up
time. They have super market shopping trips, grooming. But the 4500 is
excessive. I know one surgeon in Miami does that and calls it a gym fee. I
agree, find another doc.
— faybay
December 4, 2002
Sorry some object to my strongly worded statement. But I stand by it. Such
a fee if it becomes common will stop many needy brothers and sisters of
ours from getting this life saving surgery.<P> As fore support
groups. They are great but honestly benefit the surgeon as much as the
patient. People considering surgery seeing the success are more inclined to
decide oon surgery for themselves. Sandra how about sending this discussion
toi youyr surgeon and asking for his written explnation of the fee. That
would be interesting.
— bob-haller
December 4, 2002
Vesta, I have Dr. Ramshaw at Emory Bariatrics in Atlanta. I did not have to
pay a program fee. All I had to pay out of pocket was $180.00 for an
excellent nutrition class with a excellent nutritionist!! And this could
have been reimbursed through my insurance. Please check into some other
physicians in the area who are just as good or better!!! $4500.00 seems a
little excessive to me.
— Angela C.
December 4, 2002
Health care is expensive enough as it is. I don't know of any bariatric
surgeon living in poverty, do you? I am in the poorhouse because of my
decision to have surgery, coupled with my infant daughter's meningitis
three weeks after my surgery, BIG TIME MEDICAL BILLS. By initiating a
mandatory program fee, discrimination will occur for those who cannot
afford the fee. This is another form of fat discrimination and
discrimination against the poor or less well to do. Support groups do not
cost $4500.00, the room is probably provided or is available for a low fee
and the people that organize are not working overtime, it's most likely
built into their salaries. GREED is the dominating factor here, plain and
simple. Since we all pay outrageous fees for everything nothing will ever
be done about these forms of greed. I would run not walk away from a
surgeon that required an up front fee before approval. I should mention
that I do not currently have insurance and my surgeon's office told me that
my surgeon wants to see me regardless of my ability to pay--they would not
charge me for any services while uninsured. My health is so important to
my surgeon that she will see me even if she will not be paid--what an
amazing human being she is! Blast away!
— jenn2002
December 4, 2002
I have to say I think this is a bunch of hooey myself. My first surgeon
tried to pull the same number on me. I checked with my insurance company
and presto-chango they dropped the surgeon. I went with another surgeon and
have not had to pay anything other than my copay. I think this doctor might
not be ethical in requiring this.
— LM O.
December 4, 2002
I would guess before anyone trashes the surgeons.. and then trashes people
for trashing.. etc... everyone wait... and vesta answer a few questions..
like.. what is your insurance? Perhaps the doctors are familiar with
companies that they don't get money from.. and want to make sure they
recoup their fees. yes, this is a business, and as such... people can
charge what they think they will get.. and we all have choices... pay it..
or find someone who charges less. I had an ufront of 1200... that covers
all my follow ups for life with my surgeon... my co pays.. because despite
the fact that I have damned good insurance.. I have co pays. I'm guess
that most people also have them... support groups cost, dieticians cost..
and I'm not sure what else. I would suggest vesta that you ask
specifically what that 4500 is for and why they require it when most other
surgeons don't require that much. although my insurance basically covered
eveyrthing.. I've paid out a number of co pays over the past five minutes..
a few here.. and a few there.. maybe about $500 over that time... this
surgery is not cheap and its not free.. I know sometimes insurance makes it
feel that way.. but it just isn't. Vesta, if 4500 is just too much.. then
move on.. as you can see.. there are others that don't charge that...
— Lisa C.
December 4, 2002
I will say the one thing that I love most about living in Atlanta is that
we have so many choices of GREAT doctors. I know that my dr. is dropping
Aetna because they do not pay enough. I know that if I had to pay $4500.00
I would not be able to afford to have WLS.
What I think is funny you would NEVER hear of a surgeon charging a
"program fee" if you were having open heart surgry or a lump
removed from your breast. I know that Dr.s Waits and Macik are great Dr.s
(I have had several friends us them)but Dr.s are also business men and if
you don't like the way they do business, then it is time to find a new
dr.!!!
— Haziefrog
December 4, 2002
As of now I am not aware of any program fee. Nothing was mentioned to me
about one from the surgeon. I just talked with the surgeon's office
yesterday and was questioning whether they verified how much would be
covered by BC/BS and they do not. However, she told me they bill $6,000
for each surgeon with the goal of getting reimbursed $3,000 for each. He
and his partner always operate together, which is something I kind of liked
- 2 experts instead of just one. Once I have my approval I fully intend to
get the exact procedure code with modifier they will bill and verify how
much will be paid. I also will do the same with the hosptial and
anesthesiologist and the internist he requires be on your case while you
are in the hospital. I know the surgeon does not have a contract with
BC/BS but I will try my best to make sure the rest do. I'm almost positive
the hospital does so I shouldn't have to worry about those
charges.<p>Most insurance companies will cover follow-up with a
dietician when it realtes to morbid obesity, so you should not have to be
paying out-of-pocket for it. As far as support group meetings I have no
problem paying a reasonable fee for that, but I would prefer that fee be
spelled out separately. To just pay a lump sum fee is bogus in my opinion.
I would want to be sure I am only paying for things that I will need and
receive and that my insurance company won't cover.<p>I will be paying
a minimum of $2,000 for mine as that is what my deductible and co-pay for
the year is and it will be the beginning of the year. But then I will be
done for the entire year. I have the money put into a medical expensice
reimbursement account (pre-tax) and the $2,000 only costs me about $1,100
out of my take home pay divided by 12 paychecks. It's a pretty reasonable
way to have insurance that I can go anywhere and without a referral. If I
hadn't changed back this year and paid this much it would not even be
possible to have the surgery as the HMO's available to us even exclude
morbid obesity, whereas the fee-for-serice plan costs more but will
definitely be worth it this next year.<p>I would definitely question
in great detail what the $4,500 covers. It may well be an up-front deposit
which is still nuts. It's real easy to submit the procedure code and the
amount that will be billed prior to surgery so you and the surgeon know
what is covered. It would appear you need to be cautious you aren't being
way over-charged, unless this is THE surgeon you want - then you will just
have to suck it up and pay it. I know there are other good ones out there
that I would not agree to pay that fee, as I know my insurance should cover
99-100% after I meet my deductible and co-pay. Good Luck!
— zoedogcbr
December 4, 2002
John Rushton...if you don't deal with or know the surgeons, what gives you
any right to trash anyone!!! You are entitled to your opinion as is
everyone...BUT....stick with what you know and don't judge others. I'm
sure you don't like people judging you, when they don't even know you!!!
— Sandra T.
December 4, 2002
Bob Haller....the information should be between the doctor and patient. It
is really discouraging to see people judging others that you don't know or
deal with. I'm sure you don't like being judged that way...so lay off the
practice and let THEIR patients deal with the situation. This has gotten
ridiculous.
— Sandra T.
December 4, 2002
Sandra, I do not believe that anyone is trashing your dr.s I think they are
just saying that they do not agree with the way they do business. Not once
did I read that they are crappy surgeons, or anything like that so please
don't see it that way. I happen to agree with the one gentleman that said
that if one does this they all could do it and I could NEVER have this
surgery if I had to pay $4500.00 up front for a program fee. I think both
Dr.s are great but I would not pay that when there are so many other great
dr.s to choose from in Atlanta.
— Haziefrog
December 4, 2002
Woo hoo, is *this* a controversial thread! I'd just like to add, for
information's sake, that my surgeon charged a $1,200 program fee, payable
before surgery. That fee covered all surgery costs except for the
deductibles in the hospital bill itself, and it covered lifetime follow-up
(my surgeon's been doing bariatric surgery exclusively for over ten years).
My surgeon also had a dietician and psychologist on staff, and required
attendance at weekly support meetings prior to surgery (which were free)
and for at least six months after surgery ($15 a pop for post-ops). We
also got written instructions about what we could eat in the days and weeks
following surgery (with sample menus), and written instructions on vitamin
and protein supplements, and written instructions on types of
over-the-counter meds that we CAN take post-op and those we should avoid.
I wasn't required to pay the fee prior to approval, however.<P>I can
appreciate the views of the posters who are critical of program fees. Too
many people have made too much money off our desperation to conquer obesity
in the past. But I think Kathie (below) made a good point about docs and
insurance. The bills the docs submit may be huge, but what they get paid
is actually relatively little of that amount, and docs are getting squeezed
more and more by insurance company reimbursement limits. We as patients
get caught in the middle, since most of us really can't begin to make up
the difference (and we thought buying insurance was supposed to keep us out
of that fight, anyway). I think each person has to find out exactly what
they're getting for a program fee, and then decide whether the fee is worth
it to them or not. Personally, I couldn't have dug up $4,500, and for me
it wouldn't just been unacceptably high. Others might think that about the
$1,200 I paid, though. At six months out, I already find that fee was
worth it in terms of my doctor's caring follow-up care in my situation
(which got complicated by an unrelated cancer diagnosis two months out). I
don't regret paying the fee. But if I were the poster, I'd shop around and
compare a bit more before I'd let this fee situation discourage me from
pursuing the surgery. There are other good docs out there to consider,
too. Good luck!!!
— Suzy C.
December 5, 2002
Suzy - I paid $400 - $200 each for the nutritional & psych consults -
and my $10 co-pay for office visits (except for my 3-week and 2 month
checkup which we covered by my surgery fee).
<p>
My insurance covered my surgeons and hospital fee. My surgeon has two
nutritionists on staff and they work closely with the Weight Loss Clinic
(non-surgical) at HUP where the psychologists who do the psych consults
work.
<p>
We don't have weekly support group meetings, but do have a monthly one as
well as a non-hospital-sponsored (but attended by the one of the
nutritionists) group on Yahoogroups. There is no fee for post-ops. I
also got written instructions about what I could eat in the days and weeks
following surgery (with sample menus), and written instructions on vitamin
and protein supplements, and written instructions on types of
over-the-counter meds that I can take post-op and those I should avoid.
<p>
As someone from the insurance industry pointed out below, these doctors who
are charging program fees to get around low reimbursement rates from the
insurance companies could be in breech of contract. If the doctors were
losing money from performing the surgery, they wouldn't be doing it (or at
least accepting the insurance). That is why so many plastic surgeons will
not accept insurance any more (even if the insurance co's will pay for it)
- because the reimbursement rates are too low.
— John Rushton
December 5, 2002
This is Vesta, I started this discussion with my question. First let me
start off by saying Dr. Waits and Macik are excellent and their skills
speak for themselves and I personally don't feel any of the responses below
challenge that. However, the biggest concern here is the AMOUNT of the
fee. There is no need to dispute that a fee may be required to cover
additional expenses but who governs what that actual amount should be? What
is resonable and what isn't? I agree with one poster - this is setting the
tone for the future and since we know most of the surgeons belong to an
association pretty soon others will join in charging a high fee prior to
surgery as their "competitors" charge. But like another poster
said, would we even be having this discussion if we were heart patients or
suffering from another illness that society deems worthy to be saved? I
know how many obstacles I have to overcome to try and get approved and
covered for this surgery and it seems like, this is just one more being
added.
As for myself, I have decided that I can not afford to pay the fee while
paying for school and living on my own and so I personally will have to
search for another dr. But I just pray that this proccess does not get any
harder for others that are considering wls and that the surgeons are doing
their part behind the scenes to get laws changed for obese patients.
— vesta D.
December 5, 2002
I want to emphasize this since I've only seen it a couple of times in all
the answers. If your doctor is in-network, he or she has an agreement with
your insurance company to accept what the insurance company will pay. Any
payment that they want that is over and above your co-pay or a percentage
of the fee (depending on whether you have an HMO or a PPO) is not allowed
by the contract. Call your insurance company to verify that this extra fee
is allowed. If it is, you may need to choose another surgeon.
— garw
December 5, 2002
I wish someone would paste and mail this to the doctors involved. It would
be interting to hear their side of things. They would probably be
interested too. Negative comments here can follow them for years even if
the policy is changed.
— bob-haller
December 11, 2008
I wish mine was only $4500 I have that saved up... mine is $6800!! And I
honestly don't know where I'm going to come up with the rest... if I don't
have this surgery I am going to die it's so unfair :(
— Pink Jedi
Click Here to Return