info on Dr Husted's program?

lookthrshegos
on 1/8/09 5:33 am - Huntland, TN
I was wondering if anyone from Dr Husted's office of one of his patients might post here and could give me some info.  
Does he have a "program fee"?  If so how much is it? 
How much is the average out of pocket cost with him?
My insurance will cover the ds.  It covers 90% of the dr's fee.  100% of the hospital.
As I am sure it is with most people I have no money laying around for this surgery.  I am hoping to find the surgeon that will cost me the least out of pocket.   

Below is their requirements and what types of surgery they will cover.

Description/Scope

Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. There are a variety of surgical procedures intended for the treatment of clinically severe obesity. This document addresses those procedures.

Policy Statement

Medically Necessary:

Gastric bypass and gastric restrictive procedures with a Roux-en-Y procedure up to 150 cm, laparoscopic adjustable gastric banding (for example the Lap-Band® System or the REALIZE™ Adjustable Gastric Band), vertical banded gastroplasty, or biliopancreatic bypass with duodenal switch as a single surgery, is considered medically necessary for the treatment of clinically severe obesity for selected adults (18 years and older) who meet ALL the following criteria:

  1. BMI of 40 or greater, or BMI of 35 or greater with co-morbid conditions including, but not limited to, life threatening cardio-pulmonary problems (severe sleep apnea, Pickwickian syndrome and obesity related cardiomyopathy),  diabetes mellitus, cardiovascular disease or hypertension; AND
  2. The patient must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; AND
  3. The physician requesting authorization for the surgery must confirm the following:
    • The patient's psychiatric profile is such that the patient is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and
    • The patient's post-operative expectations have been addressed; and
    • The patient has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and
    • The patient has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and
    • The patient has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and
    • The patient's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and
    • The patient's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed.
(deactivated member)
on 1/9/09 1:06 am
(deactivated member)
on 3/1/09 5:53 am
Still no program fee! On eof the rare places that does not charge one. Thank you Jill for the comments. Sound like you have a great insurance plan in the grand scheme of things. Call Ellen first thing on Monday morning as she is the insurance person for Dr. HUsted's office. Thier number is: 606.425.4697 (Ellen Bell)

Thanks so much!

Cathi Roskind, RN, CBN
Bariatric Program DIrector
Commonwealth Bariatric Center
Dr. John D. Husted, Dr. Tommy Shelton, Dr. Rachel Shelton
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