Post by Deleted on Jan 4, 2012 19:50:36 GMT -5
First, please suggest that she post her question over here - she has joined here, and I sent her a PM, but she might not see it.
Second, "DS4Dana" is posting INCORRECT INFORMATION - can someone please post this on the thread to rebut her wrongness so it isn't sitting there, being WRONG? Thanks! (Feel free to modify my snarkiness if it is too rude sounding for your taste.)
www.obesityhelp.com/forums/ds/4487755/playing-the-waiting-game/#37132774
Someone (DS4Me) is giving you some partially correct information that sounds tinged with bitterness. Please ignore her.
To my knowledge, Rabkin does NOT participate with any insurance plans. However, he OPERATES at hospitals which do. What that means is that he will help you submit for insurance coverage, so you can get approval (preauthorization) and your insurance will cover the hospital fees, which are by far the largest part of the cost of your surgery.
However, he will require that you pay a significant percentage (2/3?) of his SURGEON'S fee, up front. When Rabkin's office submits for insurance reimbursement, he will submit for the full fee, and the insurance company, depending on how crappy your coverage is and how big your copay/deductible are, will pay some of it. If it is more than the unpaid 1/3 of his full fee, he will give you back the difference. If it is less than the 1/3, you still owe him the rest of the fee, because he does NOT agree to accept the crappy insurance coverage in exchange for being in-network.
(In contrast, DS4Dana's surgeon required a non-refundable, non-insurance reimbursable "program fee" to recoup the payments he foregoes to participate with insurance companies - frankly, I think Rabkin's policy is more open and above-board. Last heard, Jossart's program fee was $10K! Even if it was only $5K, that's outrageous - you have to pay it whether or not you need or want the services such as support group meetings or telephone consults with their staff [what if you don't live nearby? what if you dislike the peope in your group? I run a group for Rabkin and we have one or two Jossart/Cirangle patients who attend, because they think their surgeon-sponsored group, which they "paid for," sucks - and Rabkin's groups are free and open to any surgeons' patients].)
Rabkin's insurance coordinator Matt is pretty damned good at his job, and the letters of medical necessity that his office writes to request insurance coverage preauthorization (for the hospital as well as his fee - even if he doesn't participate, i.e., he's out of network - you still have to have preauthorization from your insurance company) - I know, because Larra and I* helped write them, and they rarely if ever lose. Same with their appeal letters. [*you'll probably want to change this to "Larra and the evil banned vet if you are writing it in the first person]
In CA the only two surgeons I would consider are Rabkin and Keshishian. In fact, IMNSHO, they are the only one's in the world I would consider allowing to do an RNY to DS revision.
Finally, it is HIGHLY unlikely you will get insurance approval with Rabkin if he doesn't write the letter of medical necessity. Submitting to insurance without one is pointless. I am hoping all you requested was a REFERRAL to Rabkin so you could get a consult and a LOMN from him.
IF YOU NEED INFORMATION ABOUT SURGEONS OR INSURANCE ISSUES, YOU SHOULD ASK ON THE SITE WHERE MOST OF THE VETS HAVE MOVED - OTHERWISE, YOU MIGHT GET INCORRECT ADVICE LIKE THIS.
Second, "DS4Dana" is posting INCORRECT INFORMATION - can someone please post this on the thread to rebut her wrongness so it isn't sitting there, being WRONG? Thanks! (Feel free to modify my snarkiness if it is too rude sounding for your taste.)
www.obesityhelp.com/forums/ds/4487755/playing-the-waiting-game/#37132774
Someone (DS4Me) is giving you some partially correct information that sounds tinged with bitterness. Please ignore her.
To my knowledge, Rabkin does NOT participate with any insurance plans. However, he OPERATES at hospitals which do. What that means is that he will help you submit for insurance coverage, so you can get approval (preauthorization) and your insurance will cover the hospital fees, which are by far the largest part of the cost of your surgery.
However, he will require that you pay a significant percentage (2/3?) of his SURGEON'S fee, up front. When Rabkin's office submits for insurance reimbursement, he will submit for the full fee, and the insurance company, depending on how crappy your coverage is and how big your copay/deductible are, will pay some of it. If it is more than the unpaid 1/3 of his full fee, he will give you back the difference. If it is less than the 1/3, you still owe him the rest of the fee, because he does NOT agree to accept the crappy insurance coverage in exchange for being in-network.
(In contrast, DS4Dana's surgeon required a non-refundable, non-insurance reimbursable "program fee" to recoup the payments he foregoes to participate with insurance companies - frankly, I think Rabkin's policy is more open and above-board. Last heard, Jossart's program fee was $10K! Even if it was only $5K, that's outrageous - you have to pay it whether or not you need or want the services such as support group meetings or telephone consults with their staff [what if you don't live nearby? what if you dislike the peope in your group? I run a group for Rabkin and we have one or two Jossart/Cirangle patients who attend, because they think their surgeon-sponsored group, which they "paid for," sucks - and Rabkin's groups are free and open to any surgeons' patients].)
Rabkin's insurance coordinator Matt is pretty damned good at his job, and the letters of medical necessity that his office writes to request insurance coverage preauthorization (for the hospital as well as his fee - even if he doesn't participate, i.e., he's out of network - you still have to have preauthorization from your insurance company) - I know, because Larra and I* helped write them, and they rarely if ever lose. Same with their appeal letters. [*you'll probably want to change this to "Larra and the evil banned vet if you are writing it in the first person]
In CA the only two surgeons I would consider are Rabkin and Keshishian. In fact, IMNSHO, they are the only one's in the world I would consider allowing to do an RNY to DS revision.
Finally, it is HIGHLY unlikely you will get insurance approval with Rabkin if he doesn't write the letter of medical necessity. Submitting to insurance without one is pointless. I am hoping all you requested was a REFERRAL to Rabkin so you could get a consult and a LOMN from him.
IF YOU NEED INFORMATION ABOUT SURGEONS OR INSURANCE ISSUES, YOU SHOULD ASK ON THE SITE WHERE MOST OF THE VETS HAVE MOVED - OTHERWISE, YOU MIGHT GET INCORRECT ADVICE LIKE THIS.
