VBG to DS Revision ?'s (Surgeon Decisions)

[Elizabeth N.]

Regarding Dr. K.'s $4K "Program fee": I don't know what *he* says about it, but IMNSHO getting 24/7 access for the rest of your life (or his career, which will hopefully be decades as well) to that guy's expertise is well worth every penny.

Would anyone care to guess how many people he has advised by phone and email for FREE? Try emailing him and see what happens.

He is so incredibly accessible that when I called his office with a concern that a patient of his might be in need of urgent care, he called me back from his cell phone in under five minutes. His office forwarded that message to him instantly. He pulled over in his car, took down the name and info, and acted right on the spot. Oh, and his cell number was NOT blocked to my caller ID, so if I had been the type to note that info, I could have it in my directory now.

Since he is the guy who takes on the toughest cases, he runs the highest risks, without getting paid a penny more than he would for a virgin procedure. He doesn't market vitamins and shit for additional lines of income. He does a bitch of a commute between two offices.

Those are the kind of things that tell me something about a doctor. While I realize that if you're broke, four grand might as well be four million....IMSNHO the guy's a hell of a bargain.

 

[brooklyngirl]

Ok, that makes a little more sense

 

[jillc]

I talked to Dr Keshishian myself - he phoned me and talked about my case. Asked me some pertinent questions about my hypothyroidism, depression, etc. I found that very impressive.

He probably didn't find me too impressive as I tripped the fire alarm whilst talking to him. I was barbequing a burger (we live in 'shacks' - trailers with two living quarters a shared laundry and a propane powered barbeque outside, if you open the front door too long when checking on the bbq and you set off the alarm -) . I explained that to him and then he enquired about what I was eating.


And his staff were very knowledgable. And a 1-800 number accessible from Canada (my MagicJack app doesn't work out here).

 

[Sheanie]

@brooklyngirl , after working with the dental insurance industry for almost 25 years, I can tell you why doctors don't discount their fees for cash-paying patients. Because they sign contracts with the insurance companies not to. At least, they don't advertise they will. If YOU can get a discount for paying cash, DO IT. But I know we had to sign a contract with Delta Dental back in 1983 that we would not "discount" our fees for anyone, senior citizens, cash patients, etc., without also offering that discount to Delta Dental patients. DD patients, it should be noted, at the time had 35% of their bill "adjusted" off, at a loss to the doctor, as part of being a "participating" dentist.

It's a well known fact that if a newly graduating doctor or dentist started out as "Non-Par" (did not participate in ANY insurance, but merely billed it for the patient), that they could charge 25% less than anyone else, at the very least. And still turn a very healthy profit, unencumbered by the insurance company trying to practice medicine without a license. I urged my husband to do this in 1983, but failed. We now "write off" approximately 40% of our fees to the insurance company. So yes, health care is artificially inflated, to cover the write-offs.

 

[brooklyngirl]

But I know we had to sign a contract with Delta Dental back in 1983 that we would not "discount" our fees for anyone, senior citizens, cash patients, etc., without also offering that discount to Delta Dental patients.

This part is crazy. So what's the benefit for the doctor? More patients because they get "advertised" as participating by the insurance company?

 

[Spiky Bugger]

Regarding Dr. K.'s $4K "Program fee": I don't know what *he* says about it, but IMNSHO getting 24/7 access for the rest of your life (or his career, which will hopefully be decades as well) to that guy's expertise is well worth every penny.

Would anyone care to guess how many people he has advised by phone and email for FREE? Try emailing him and see what happens.

He is so incredibly accessible that when I called his office with a concern that a patient of his might be in need of urgent care, he called me back from his cell phone in under five minutes. His office forwarded that message to him instantly. He pulled over in his car, took down the name and info, and acted right on the spot. Oh, and his cell number was NOT blocked to my caller ID, so if I had been the type to note that info, I could have it in my directory now.

Since he is the guy who takes on the toughest cases, he runs the highest risks, without getting paid a penny more than he would for a virgin procedure. He doesn't market vitamins and shit for additional lines of income. He does a bitch of a commute between two offices.

Those are the kind of things that tell me something about a doctor. While I realize that if you're broke, four grand might as well be four million....IMSNHO the guy's a hell of a bargain.

I once called him and asked for a PPI Rx. Within about two minutes, my pharmacy called to confirm that I was the
right patient for the Rx that had just been called in. It was, I believe, a Sunday evening, about seven years after my surgery.

 

[Barb1]

I agree totally with everyone about Dr. K!! My sister is still telling anyone who will listen how wonderful and personable he is!! He also has a way of explaining things that anyone can understand. He is a great man and a very very knowledgeable surgeon!! Oh how I wish I could have found a way to self pay in 2010. He was not covered at all by the insurance I had at the time. When I went to him last year I luckily had BC/BS. I would recommend him to anyone.

 

[Millie]

@brooklyngirl - I haven't heard/read anything from/about DeeDee/Diane in quite sometime. I'd say, at least a month. Hers is one of the worst scenarios I've read about. I hope everything works out for her.

 

[DianaCox]

There was an update about DeeDee about 2 weeks ago - she's doing better. They finally found the leak/abscesses and drained them and she's doing better, but she's been sick for a long time, so she will have an extended recovery.

 

[brooklyngirl]

It's a shame, I hope she has a better recovery this time.

 

[Larra]

Diana, thank you for the update. Now that they have found and attended to the problem she should get better, though it may be a slow process. DeeDee, if you are reading this, we wish you well and hope for a full (if slow) recovery for you!

 

[Sheanie]

Yes, @brooklyngirl , the benefit for the dentist (presumably, it's considered a "benefit") is that Delta Dental then lists you as a Participating Provider. We never had a problem attracting patients. We have a very large number of cash-paying patients. I put quotation marks around "benefit" because the only patients that I have EVER had to take to Small Claims Court in order to collect from were Delta Dental patients. They only had a 20% co-pay, and some of them felt that they shouldn't even have to pay that much. Back in those days, I still cared very much what people thought about me. Now I have no such feelings, and quickly send bad accounts to an agency, who employs a lawyer to do the collecting. And the patient is dismissed.

 

[babs71958]

In regards to insurance: there is what is called,
Usual, customary, and reasonable (UCR) charges - Conventional indemnity plans
operate based on usual, customary, and reasonable (UCR) charges. UCR charges mean
that the charge is the provider’s usual fee for a service that does not exceed the customary
fee in that geographic area, and is reasonable based on the circumstances. Instead of
UCR charges, PPO plans often operate based on a negotiated (fixed) schedule of fees that
recognize charges for covered services up to a negotiated fixed dollar amount.
I agree that if a patient is paying cash, a discount should be given.

 

[jillc]

Just an update - I had a Skype conversation with Dr. Marchesini on the 6th of August. Sorry for the delay in reporting but I got medical tests done, then booted off to a writer's conference, then I flew to Phoenix and drove down to Algodones for dental torture (root canal, crown lengthening aka burning your gums with a laser, posts and 5 crowns & 1 extraction). I'm now back at work with a sore mouth. But this work would've cost $10,0000++ in Canada.

Anyhow, back to Marchesini. It was a good conversation. I wish I would have screen cap'd the Skype conversation but it was 5 am and my brain wasn't that quick.
He does revisions lap. He said (I'm paraphrasing) that the lap cameras enlarge everything so it's much easier for him. If there were many adhesions, he would have to open me up.
I asked him if the VBG conversion wasn't possible, what would he do? He said he'd do an RNY. I didn't react at the time, but there is no way in hell that I am getting an RNY. What Roslin says about retaining the pyloric valve/pylorus makes sense to me. So I emailed him today and asked him if he would consider (if the VBG to sleeve conversion wasn't viable) just doing the Switch portion.

I would love to get rid of my VBG, but I don't want to exchange it for an RNY. That would be a shitty article, IMO.

Have a phone consult with Greenbaum scheduled on the 22nd. Will tell you how it goes.

 

[Barb1]

Just an update - I had a Skype conversation with Dr. Marchesini on the 6th of August. Sorry for the delay in reporting but I got medical tests done, then booted off to a writer's conference, then I flew to Phoenix and drove down to Algodones for dental torture (root canal, crown lengthening aka burning your gums with a laser, posts and 5 crowns & 1 extraction). I'm now back at work with a sore mouth. But this work would've cost $10,0000++ in Canada.

Anyhow, back to Marchesini. It was a good conversation. I wish I would have screen cap'd the Skype conversation but it was 5 am and my brain wasn't that quick.
He does revisions lap. He said (I'm paraphrasing) that the lap cameras enlarge everything so it's much easier for him. If there were many adhesions, he would have to open me up.
I asked him if the VBG conversion wasn't possible, what would he do? He said he'd do an RNY. I didn't react at the time, but there is no way in hell that I am getting an RNY. What Roslin says about retaining the pyloric valve/pylorus makes sense to me. So I emailed him today and asked him if he would consider (if the VBG to sleeve conversion wasn't viable) just doing the Switch portion.

I would love to get rid of my VBG, but I don't want to exchange it for an RNY. That would be a shitty article, IMO.

Have a phone consult with Greenbaum scheduled on the 22nd. Will tell you how it goes.

If I had my VBG taken completely down and I had the Marlex band I don't know why you couldn't. Grant you mine was breaking down at the top but was mostly still intact. Again good luck and I sure wish you could see Dr. K but fully understand why you can't.

I told Dr. B when she did my revision that I absolutely did not want a ERNY or RNY. That if she couldn't do the DS to just try to take down the VBG and give me a normal stomach if possible. I was plain tired of puking.