Self pay $13k for DS vetted surgeon in NJ

[Mike Powers]

I wanted to share this with anyone interested in self-pay for DS surgery. I am not a candidate for DS surgery through Cigna who requires a minimal BMI of 50 (I think with Co-morbidities) and this is the only surgery I want. I was only looking at Mexico as I thought financially that would be my only option when I saw something on one forum or another regarding self pay in Pennsylvania being a reasonable option. Upon doing more research, I found a highly vetted surgeon in NJ (Dr. Greenbaum) who quoted me $13k for the procedure which includes 4 days hospitalization, surgery, anesthesia) the additional things I must get are an endoscopy (my insurance should pay) and a appt with a nutritionist (again - looking to have insurance pay, we'll see.

I spoke to the patient coordinator asking her "is there ANYTHING ELSE that could be an out of pocket expense?" She said that Dr Greenbaum also does a liver biopsy (CPT code 47000/47100) and a radiological "leak"test post surgery (CPT code 74240/74241 depending). My next question was - ok what does that cost? She didn't know - WTF.

Luckily, I found a terrific person in the billing office at the hospital that gave PHENOMENAL service and did a couple things - 1) since I was having surgery there they worked on the price 2) being self pay, only paying 12% of cost - she is sending me paperwork for approval and confirmation/documentation that allows me to pay 12% of the cost as a self pay - the 2 additional procedures would cost $2100 and at self pay will cost me $252 - I can deal with that.

I was prepared to go to either Dr. Aceves or Dr. Ungson - whose prices are almost the same but this saves me from flying from Philadelphia to San Diego or deeper into Mexico for Ungson. Ungson seems amazing too as a doctor yet I don't love flying that far after surgery and at a lower price (unless complications) I have a vetted DS surgeon about 1 hour away. If I do have complications, Greenbaum says the hospital will cost about $850/day additional. Luckily, I also have a voluntary plan that will pay $500/day to me when I'm hospitalized for the first 5 days and a surgery benefit then $100/day after that - so that too will help with the cost. Wish me luck and no complications!!!!

Scheduled 6/30/2014, nervous but I can't wait!!!

 

[DianaCox]

Before you have surgery, PLEASE submit a request for precertification. Even if you are denied, and go ahead as a self-pay, you can appeal for reimbursement. Larra and I can help - our success rate is way over 90%.

But you must have a denial BEFORE you self-pay to vest your appeal rights.

 

[Mike Powers]

Wow - I think I'm in love - wish I wasn't already married!!!JK Thanks so much! If I didn't go for the DS any other WLS would be $50 total out of pocket! That would be awesome and my wife would be much happier but DS is the only way I want to go though I am getting nervous ready some of the comments on how lousy people are feeling after surgery. No Pain No Gain (or loss in this scenario)

 

[southernlady]

DS is the only way I want to go though I am getting nervous ready some of the comments on how lousy people are feeling after surgery. No Pain No Gain (or loss in this scenario)

Right after surgery, yes we can feel absolutely like dirt! But it DOES get better.

It's a BIG 18 Wheeler called the DS Welcome Wagon that runs over you, backs up (running over you again) and then runs over you AGAIN!

But it is SO worth it.

 

[Mike Powers]

Diana, I just called Cigna to ask about getting a pre-certification and they said I can not request it but the doctors office requests it - however Dr. Greenbaum is not in my network so would I still try to get a precert? There is a doctor in PA that does the DS per DSfacts but when I called his office for self pay the person said self pay would be $25k+

 

[Mike Powers]

Right after surgery, yes we can feel absolutely like dirt! But it DOES get better.

It's a BIG 18 Wheeler called the DS Welcome Wagon that runs over you, backs up (running over you again) and then runs over you AGAIN!

But it is SO worth it.

Thanks SL - I know you were a light weight too so I really appreciate your feedback experience! MP

 

[DianaCox]

I would ask an in-network DS surgeon to submit for precert. Then you can use Greenbaum because there is no good reason nor necessity to use a more expensive in-network surgeon when you were self-paying at-risk.

Who is you in-network option?

 

[Mike Powers]

I would ask an in-network DS surgeon to submit for precert. Then you can use Greenbaum because there is no good reason nor necessity to use a more expensive in-network surgeon when you were self-paying at-risk.

Who is you in-network option?

Dr. Bonnani out of Abbington Hospital PA

 

[DianaCox]

Go get a consult and get his office to submit for precert ASAP. Don't let them say there is no way - tell them to submit anyway. But ask to let you review the LOMN before it is submitted. Larra and I will review first. If you get a denial, you can go ahead with your self-pay with Greenbaum.

 

[brooklyngirl]

Noting much of value to add, just wanted to say that Dr. Bonnani was in the OR for my DS and I liked him a lot. Best of luck with the appeal process!

* I realized that might've sounded like I was saying you should have surgery with him, not what I meant! just that he seemed like a nice down to earth guy if you have to do the pre certification process with him

 

[Larra]

Hi Mike! thanks for posting about this great self-pay option. And as Diana said, we will help you fight your insurer if we can.

 

[Munchkin]

Great price!

 

[Mike Powers]

Thanks everyone for everything - fyi, it's kind of funny because I'm getting a little push back from my wife regarding this surgery and when I respond to her questions and statements she wants to know where I've gotten all my facts - I don't tell her about the various forums I've done research on beyond the web - but as we all know there is SO MUCH mis-information out there with people with their own questionable agenda - I find these forums to be such a great resource - though I don't bet the bank on any one statement - I find when you gather everything up and do your best to separate the chaff from the wheat - this and other forums are such a great resource and I want to let you all know how much I appreciate everything you all do here and pray for blessings upon you. I just want to pay it forward too.

 

[southernlady]

Thanks everyone for everything - fyi, it's kind of funny because I'm getting a little push back from my wife regarding this surgery and when I respond to her questions and statements she wants to know where I've gotten all my facts - I don't tell her about the various forums I've done research on beyond the web - but as we all know there is SO MUCH mis-information out there with people with their own questionable agenda - I find these forums to be such a great resource - though I don't bet the bank on any one statement - I find when you gather everything up and do your best to separate the chaff from the wheat - this and other forums are such a great resource and I want to let you all know how much I appreciate everything you all do here and pray for blessings upon you. I just want to pay it forward too.

Mike, why not have her join here and also read DSFacts as well...she may have questions you haven't thought of.

 

[Elizabeth N.]

Mike, if it would be helpful to meet in person with you and your wife, I'd be happy to do so.