Does anyone know why?

Hi... Does anyone know why Lap-Band surgery through Priority Health is not covered through the hospital in Ypsilanti? I have been told that my doctor is a priority health participant, but that the Barix Clinics hospital in Ypsilanti is not covered. I would have to go through the MMPC weight loss bariatric program in Grand Rapids. I would prefer at this point, to go through Ypsilanti and not Grand Rapids, but Priority is saying that they would not consider that hospital unless they are "participants". They would not consider it out of network because they say that Grand Rapids is in network and in my area. What a mess. Who has had any experience with this and what can anyone tell me about this? Seems like Priority has gotten very bad track record with bariatric approval as well. Thanks for any info. that anyone has... Martha in Holland

I don't know about Priority, but I know that when I had HAP, they would not cover lap-band, only RNY. It could be that they consider Barix NOT to be a "hospital" (by Priority Health), as perhaps they only concentrate in Lap-band and RNY and nothing else. You can't go to Barix if you are having a heart attack. right?? Please, I want you (and others who are reading this reply) that I am NOT bashing Barix!!

It is becasue Barix does not have a contract with Priority health so that is why they will not let you have services with the facility. It means that Barix does not agrea to what Priority pays for the procedure as payment in full and if you have the services at Barix you can be balanced billed the amount that Priority does not pay. They recomment MMPC because they are considered a center of health excellance and contract with Priority and that is why priority is refering you to the practice. You could still go to barix but you would be using your out of network benefits and would be expected to pay the difference which is a 20% copay. Tricia

This is all so tricky. Priority told me that they would not cover any fees if I went to Barix because they are out of my network. That I could go to Grand Rapids MMPC and have it covered, if I met their terms. ( Wish from what I understand is growing rapidly harder and harder to do....) Yet, I find that the doctor I know at Barix has done over 200 of these procedures, and the ones at MMPC have only done under 60 each. This makes a definite deal breaker for me. I would rather go to someone who has done many of these than someone who has done just a few. I am trusting my life to this person and I want to be sure they are well-versed in their knowledge. I feel cheated, as I know many others do, that their insurance companies have taken away their choices. We can no longer choose who we want to trust our lives to. It is up to our HMO's and not ourselves. Maybe the surgeons and Grand Rapids are fine, but they have yet to win my trust. Martha

martha, Please email me.. Thanks. Robin [email protected]

Martha, I had my roux-n-y done by Dr. Foote at MMPC. I find that he and Dr. Kemmeter are very caring doctors and are very knowledgeable. I can't attest to Dr. Baker because I don't know him. Have you gone for an orientation? If not, maybe set one up and just listen and ask lots of questions. This might make you feel more comfortable with going with MMPC.

I am currently going through the process..no surgery date yet...just starting my tests..but I am going through mmpc..I have researched this surgery for almost five years now and I am very confident in the doctors at mmpc. I do know they have done MANY rny and have started to step up the amounts of lap band. I would suggest the same as the other poster suggested and go to a orientation...they are wonderful. I did also question doing the lap band and they defiantley do them at mmpc but they told me I would not be that happy with the lap band being the amount of weight I want to lose. Good Luck in your pursuit. Melissa