Self-pay through Dr.Rabkin

[Platti]

Hi there,

Newbie here I'm going to be a self pay for a revision to DS through Dr. Rabkin most likely. I say most likely because due to COVID-19, I do not have a lot of the documentation of failed weight loss attempts (such as through Weight Watchers) as I would have and in having lots of time to marinate on the revision at home, I've decided to just pull the trigger and do it.

Has anyone else been a self-pay patient with Dr. Rabkin?

My main question is about his fees - He has his surgeon fees which I will be paying, but would it be possible to bill the rest to my insurance? Or if they try to bill my insurance and they deny the revision to VSG, would they still cover the hospital bills?

Other questions:

• What was your experience like with Dr.Rabkin? Was he friendly? Attentive? I've been reading about Dr. Keshishian and he has rave reviews about his charming personality but I have seen nothing (good or bad) about Dr.Rabkin
• Does Dr. Rabkin check in on you in the hospital?
• How larger is your open surgery scar?
• How long until you were feeling somewhat recovered and moving around well?
• any regrets?
• Complications?
• advice?

I'm very nervous (more-so than I was when I initially had my VSG done 10 years ago.)
I've slowly regained though my food choices aren't bad (i've been tracking) and have tested my restriction and can eat 1/4-1/2 of a large pizza in one sitting without feeling that icky slime feeling. Overeating is possible but not something that I engage in often as I hate the overly stuffed feeling.
Vitamin levels are good, anemia has always been there.

Any and all advice is welcome, I've lost the majority of my old support system due to relocation and could use kind words

Hello! Welcome! I cannot answer your questions directly, but Dr. Rabkin is well respected, and many people like him (and his bedside manner) very much. I considered both Dr. R. and Dr. K as options and went with Dr. K due to insurance coverage. When I talked with Dr. Rabkin's office they required cash payment upfront and would give the insurance reimbursement (if any) to the patient instead of accepting direct pay.

Why don't you get in touch with his office and see if you can get some of your questions answered? It is always better to have all the information before you make a decision.

Welcome Platti

welcome, Platti!

Welcome!
Dr. Rabkin and Dr. K are both very fine surgeons, and both are good people as well. Personality wise, you wouldn't go wrong with either of them.
As far as your insurance goes, you need to get your hands on your EOC (evidence of coverage) to see what coverage you have not just for bariatric surgery but specifically for revision bariatric surgery, which often has different requirements, or is sometimes not covered at all. This is a lengthy (like 100 pages) document with all the specifics, not a brief summary of coverage. You should be able to get it through your or your spouse's HR if that is the source of your coverage, though from what we've seen it can be difficult to get and sometimes the folks in HR don't know what it is, so go up the food chain if you need to. You might be able to get it through your insurer.

Welcome!
Dr. Rabkin and Dr. K are both very fine surgeons, and both are good people as well. Personality wise, you wouldn't go wrong with either of them.
As far as your insurance goes, you need to get your hands on your EOC (evidence of coverage) to see what coverage you have not just for bariatric surgery but specifically for revision bariatric surgery, which often has different requirements, or is sometimes not covered at all. This is a lengthy (like 100 pages) document with all the specifics, not a brief summary of coverage. You should be able to get it through your or your spouse's HR if that is the source of your coverage, though from what we've seen it can be difficult to get and sometimes the folks in HR don't know what it is, so go up the food chain if you need to. You might be able to get it through your insurer.

From what Matt (from Dr. Rabkins office) sent over, I am cover for my revision through BSofCA.

“Here is the documentation Blue Shield requires, according to their published criteria:

- Documentation of your having failed to lose weight to the point of your body mass index being less than 35 at the time of surgery, via non-surgical measures (including medication and nutritional counseling) for 3 of the past 6 months before surgery, despite one of the following:

1. Your having participated in a documented (including your initial weight, end weight, and the start date and end date), structured, physician-supervised weight-loss program which includes an exercise program as tolerated or available; or
2. Serially-charted documentation (including your initial weight, end weight, start date, end date, and notes from two clinician-directed follow-up visits) of your having participated in another managed weight-loss program including dietary control and exercise as tolerated or available (this option includes commercial programs, dietician-supervised programs, and diabetes management programs).

- A sleep study report which shows that you have clinically significant obstructive sleep apnea (which Blue Shield defines as an apnea-hypopnea index [AHI] of at least 15 events per hour, or an AHI of at least 5 events per hour in a patient with excessive daytime sleepiness or hypertension).

- A few different checklist-type documents, which you and/or Dr. Rabkin would need to complete and sign (I can send these to you if/when needed). They also need the person who did your psychological evaluation to complete a checklist, and I can send that to the evaluator and have them get it back to me.

- Documentation of your weight loss history after your VSG.

- Documentation of your having complied with your VSG surgeon's diet and exercise recommendations.

- The operative report from your VSG.

- Blood Work (I can send you an order for the specific things they need).

- A chest X-Ray.

- An electrocardiogram.”

My biggest concern is the first item. What exactly would check this box?
I will contact my HR and see if I can get a hold of my evidence of coverage document. I believe I may have it in an email as I remember taking a look at a bulky document but I could be wrong

UPDATE - I spoke with Matt this morning, Dr.Rabkin's self-pay total comes to around $35,000 which is a lot higher than what I had imagined/prepared for. I will be trying to go through my insurance instead.

moved thread over to the Revisions Forum: https://bariatricfacts.org/threads/vsg-to-ds-by-dr-rabkin-sf.7947/

Thanks for your help guys

Do you live near either the Bay Area or LA?

Do you live near either the Bay Area or LA?

I live in the Bay Area

I live in the Bay Area

That would play into my decision-making. In fact, it did.

I started at USC Hospital, because back then (15 yrs ago), there was an experienced DS surgeon there. Then I went to Keshishian, about a 3.5-4 hour drive. (He has since moved to the LA area.). I would have, at least, TRIED to justify the out of pocket cost at the (then) Rabkins‘, many hours away, but once I met Keshishian, it was a no brainer.

But...what are YOUR priorities? If Rabkin and Keshishian were located in the same place and handled billing the same way, It would be a tougher call, right? LOL Is rapid access more important? Will you HATE the long trip home? Do you need to NOT hit up your 401k to pay for this?

 

[southernlady]

Okay, guys, messed up. Instead of merging two threads, I merged all the replies to this post into one. Can’t undo it.

I'm gonna close this one and continue on the other one.