Question:
Would this idea work?

Hello all. Can anyone help? I have a insurance/billing question. You all know I've been approved and am having surgery on March 1st. Well, I will be my surgeons first Lap patient. He's been only doing open up to this point. My insurance pre-cert approval letter said "MBA has reviewed your request for preauthorization of gastric bypass surgery. The services as presented are eligible for benefit coverage under the current benefit plan". When I expressed concern to the surgeons office that lap is more expensive than open, and that I was afraid that I'd have to pay a bunch more out of my pocket, she said that the letter originally sent to them DIDNT specify what way it was going to be done. (open vs lap..this is true, I saw the letter that was sent) And she said that they use the same code when they bill it.<BR><BR> Now, my question to all of you WLS experts (and I know that there are insurance people in AMOS land too)is: SHOULD I TRUST THIS SITUATION, AND IF NOT, WHAT SHOULD I DO? GET SOMETHING IN WRITING? I have to be honest with you, even though I am an assertive person, I really feel funny about this. It's kind of like saying, I dont trust your office. I don't want to offend them. But on the other hand, they have ME sign something saying that I'm responsible if the insurance DOESN'T pay! I suppose because on the bottom of the approval letter it states "There is no guarantee of benefits until the actual claim is received and reviewed" WHATS UP WITH THAT? Basically, this letter means squat!!!!!!! LOL<BR><BR>Another question:DO YOU THINK IT WOULD BE OUT OF LINE TO ASK THE OFFICE, CONSIDERING MY INSURANCE ONLY COVERS 80%, AND CONSIDERING THAT I AM THE FIRST LAP PATIENT, THAT THEY PICK UP THE 20%? Is that too tacky? I have heard of people making deals before, and it IS his business. What do you all think? I'm hoping with 60,000+ members here, someone will be able to help! Thanks a bunch! *****GretcheeGirl*****    — blank first name B. (posted on February 15, 2002)

February 15, 2002
Hey Gretchen- Congrats and good luck with your surgery- I would confirm with my insurance company that the Lap is covered-...BUT are you sure you want to be the first Lap the MD is doing- I have not had my surgery yet- but I work for a hospital and I would not want to be a DR's first anything!!! Espeically something as majot as this- I was told by the clic here that they prefer open over Lap due to the increased leak rate when done laproscopically- so my 2 cents *~*
   — ~~Stacie~~

February 15, 2002
Here's my opinion. I don't think that the lap surgery could possibly be MORE expensive than the open surgery, since you would be staying fewer days in the hospital overall. I may be wrong, but regardless, I would seriously doubt your insurance company would care. And if they throw a fit, you already have their letter saying they would cover the procedure.
   — Terissa R.

February 15, 2002
I too think it's awfully risky to be a first Lap patient since Lap already have an increased risks of leaks which can be life threatening. My doctor is an expert in both and I know someone was his first but I wouldn't knowingly have wanted to be it. I chose open because my surgeon charges less because it's a shorter surgery and there was less health risks. My surgeon keeps opens in the hospital for 2 days (I ended up there 3 days because I had a fever) and lap's 3 days because of these increased risks. He said some surgeries are better lap but rny are not because of the position of everything. Also, he said the less time an obese patient is under the better for them. He does Laps because of patient demand.
   — Candace F.

February 15, 2002
Actually, lap could be more expensive, since it takes quite a bit longer. Therefore, more operating room time, which is usually billed by the hour, more anesthesia, moe time for the anesthesiologist. As to being your doctor's first lap patient, has he assisted in other lap surgeries? Does he have someone with experience in lap procedures assisting him?
   — garw

February 15, 2002
Thanks everyone for your input. I asked for and got what I wanted...your honest opinions. I have to tell you all that I did not go into this being his first lap patient blindly. I am an intelligent, very cautious, slightly suspicious in nature, middle name is "why" (I ask alot of questions & need to know everything!lol),analytical kinda gal. My surgeon has performed lots of open RNYs and has performed lots of lap procedures. He even has been using the tools for the lap on patients while doing the procedure open just to "practice". Then he & his partner went to a seminar in CA just recently to learn how to put the two together for real. I also feel that SOMEONE has to be the first. I, and my surgeon, feel that I am the perfect candidate for this, as I am very tall(5'11") and have a BMI of 40. Meaning I am very stretched out! LOL Also, I had my gallbladder taken out lap about 12 years ago. And I am in good health for surgery. My personal opinion of being the first is a surgeon will be EXTRA careful with me since I AM first....no laxadaisyness(is that a word?)or "sloughing off" because he's done this so many times he could do it in his sleep. Now you and I know that hopefully no Dr would ever have this attitude, but thinking that way is the same as thinking a Dr would be anything less than perfectionistic with his first. And like I said before, I feel that with his first he's gonna be EXTRA careful. Its not like this is the Dr's first surgery ever! And last but certainly not least...God will take care of me.<BR>Your right Gar, the lap is more expensive. Thats what I'm worried about. That the bill the insurance company gets will not be paid by them because the surgury is above the "usual and customary fee" for this surgery. The letter to them didn't specify lap. Then who would be stuck? Me!<BR>About the insurance fraud comment, how silly! First off, I am one of the most moral people you will ever know and wouldn't ever dream of doing anything immoral. I was simply wanting to know if it would be "tacky" to ask for the Dr to waive the balance that is left for me to pay, AFTER the insurance company paid the 80%....because I am his first. And the proof is right here, not many people would be willing to be his first!!! SO....I thought I should get a discount!!!! Make sense?<BR>
   — blank first name B.

February 15, 2002
I had a great deal of trouble getting my insurance co to approve lap surgery. They had approved the open but denied the lap. After 2 appeals and an outside review board I was approved. If I had gotten the lap it would have ALL been out of pocket!!! Please check with your insurance co. I personally would not like to be a Dr first surgery. You can always change surgeons. The first time they perform surgery it generally takes the longest. After a couple of hundred it take 1/2 to1/4 the time in surgery. Good Luck
   — Robert L.

February 16, 2002
Gretchen - My surgeon finished his residency in July and he did my surgery in November. I was "his" first bariatric surgery patient. However I wasn't scared because he does the surgery with the surgeon who trained him and has been doing the surgeries for 2 years. So it was really like having the more experienced surgeon doing the surgery even though technically I'm listed as the younger doctors patient. I knew that he would be ESPECIALLY careful with me since I was his first surgical patient and everything went very well. He also ALWAYS remembers me and the office staff has said how he brags about how well my surgery went!! So I get a little extra special treatment too!! You can always ask the doctor's office to waive your 20% coinsurance since this is the first time he's doing the procedure. The worst they can say is no. However if they say yes, look at the money you saved.
   — Patty H.

Click Here to Return