Program Fee for WLS?

Thanks for the welcome Mike! We are from Elizabeth City, NC. Hubby is in the Coast Guard, so we are going to spend the next 4 years here now. I am looking to have either lap or open RNY. My insurance does not cover Lap Banding and I don't think it would be right for me. Although I can't get over the success everyone has had with it. We have Tricare Prime, so the surgery itself and hospital fees are all covered, with a $12/per day in hospital co pay. I would love to attend a support group. I have attended one seminar and one support group in Newport News, VA. I sought out Dr. Clarke there. He was a great doctor and if we had not moved, I would have done what I could to come up with his program fees. I have not worked in 2 years, due to I suffer from Arnold Chiari Malformation and Fibromyalgia and Depression. So coming up with these program fees is really tough for our family. We have a 2 year old and with my special needs, I am sure some of you can relate. Keep me updated on the OH support group you are working on. Thanks again!

Hi Mandy, Just a heads up - Tricare does not pay everything. They tell you that they pay 100%, but that is 100% of the "usual and customary" which isn't necessarily what the surgeon charges. And Tricare requires you to pay the surgeon's fee up front if the surgeon is out of network (and then Tricare will reimburse you the 100% u&c). So you may want to call Tricare and ask more questions to help you plan. HTH, Kristen

Welcome to Florida and Pinellas County. As with Mike, I also had Dr. Ernest Rehnke as my surgeon. I had LAP RYN 9/1/06 so I'm not too far out. I havent had any complications up to this point. His patient forum can be found at www.obesitynomorefl.com The only "additional fees" not covered by insurance is the Two-week optifast liquid diet (it sounds harder then it really is once you get started) and the $25.00 Orientation fee. It costs $200.00. You get 3 cases of the stuff and it comes in chocolate, vinilla, and strawberry. Your psychological evaluation can be covered by insurance potentially if you use Dr. Baum for it. He does require a sugery buddy (someone who will help you through and support you through the process) which should you decide to use Dr. Rehnke will not be hard to come by. The siminars and support meetings are free of charge to attend (which you would have to attend two, plus orientation). Feel free to message me privatly for more information into the process

Check with Drs. Gordon and Gonzalvo in Largo. They do not have a program or administrative fee. Both are fellowship trained and have excellent results. They operate at Morton Plant Hospital in Clearwater which has does have a bariatric program in place. Their office number is 586-3751. The person who does billing etc, name is Sherry. Welcome! Julie

Mandy, I am in the Florida Panhandle (Panama City), and so am not familiar with the surgeons in your area, however, I too have Tricare Prime insurance as I am retired from active duty. I had my surgery here in Panama City in April of this year and there were no program fees at all. Everything was covered by Tricare, including the Psych evaluation and the other tests my surgeon wanted done before WLS (Colonoscopy, Endoscopy, Abdominal Ultrasound). The only out of pocket expenses that I incurred in the whole process were the $12.00 co-pays for the each of the visits to the specialists and the surgeon, and a $25.00 co-pay for the hospital. The grand total was less than $80.00 from the initial consult to the present whi*****ludes 4 follow up appointments with my surgeon since the surgery date. I am sure that you can find a better situation than the one you described. I hope this information is helpful to you, and welcome to Florida. Jerry

Welcome Mandy! I am also Tricare Prime, (ret military). I used the most wonderful caring Dr. I ever met, not even joking a little. He is Dr Michel Murr at Tampa General Hospital. His office is in Harbourside Towers Suite 300 right at the same site. He has seminars every month at the hospital but you will need to check if its the 2nd week of the month still. He also has Post op meetings so you can be sure to have followup care. I live in So West Florida and travel 3 hours up and 3 hours back to see him as well as at least 3 others I know of. His number is listed in our info from Tricare but wait, I will get it fot you now. 813-259-0920 for appts. He is chief of surgery and has preformed many gastric bypass both open and laproscopic. I was so lucky, was approved for open since Tricare Prime only covered that at the time...a few weeks before surgery they approved lap so their office resubmitted my information and I was approved within 4 days. Also he uses a separate office for cardio, physcologist and dietican. If you decide to use them, let me know I can give you some advise on this and who not to make your phys appt with. If you want anymore information on him you can read my profile or email me directly.

here in pensacola area program fees are about $425.00

You won't receive the real information that you are looking for unless you compare apples to apples. Some docs don't charge you a program fee, but will charge you for aftercare, pre-op education, metabolism testing, etc. Before you select a surgeon, find out exactly what the program fee includes. You might discover that it ends up being less expensive in the long run. Welcom to Florida! Kristen

Your best bet would be to call Tricare and ask for referrals. They will give you the names of in-network surgeons. It is true if you use an out of network surgeon you will have additional costs. And just calling and asking "do you accept Tricare" does not necessarily get you the information you need. There are two categories of Tricare providers -- those in network for Tricare Prime and those that accept assignment. Many physicians who accept assignment will also accept what tricare determines to be the "maximum allowable" (or whatever they are calling it these days), but some will not accept the Tricare maximum allowable as final payment -- and you will have to pay the difference. In some cases that could amount to thousands of dollars, because Tricare only pays about $1400.00 to the surgeon here in Florida. I have tricare standard so it makes very little difference to me cost wise which one I use as long as I make sure the doc accepts the maximum allowable charge-- but since you are prime it could make a big difference. If you get a list of providers from Tricare -- you can then come here and get feedback on them. Also be wary of any program fee a network provider wants to charge you and check with Tricare before paying. It depends on many factors but it may be illegal to charge you a program fee, because the in-network provider has signed a contract with Tricare certifying that they will accept the maximum allowable charge as payment and by law they cannot charge you more. But here again it depends on who you are paying the fee to and how it is structured. But Tricare is your best source of information on this. Red