Robotic Surgery and Insurance

I was wondering if anyone has had a similar experience?

I met with a robotic surgeon yesterday. They told me that my insurance did not include a code for robotic surgery. I would have to make up the difference out of pocket. This is about $3200 and would need to be payed a week before the surgery, in cash.

The first urologist I went to told me my insurance did not pay for local anesthetic for the biopsy. I would have to pay $250 out of pocket for some comfort. Guess what, my insurance company did pay it. They just had a nice racket going. They are breaking the law. Don't wanna cast aspersions.....but sounds fishy to me. Do what Steve says.
Paul

For most insurance companies, robotic surgery makes sense because of the saving in hospital days. Definitely call the company. If your insurance is through an employer, then call the HR department and ask them to run interference for you (they don't get put on hold for hours.) My HR people have gone to bat for me several times -- all with good results.

Dear crew:

You should report this back to your insurance company immediately.  My understanding from my insurance company (CIGNA) is that, when a physician/hospital agrees to accept their insurance they also agree to accept the schedule of payments as approved by the insurance company.  I have never had a physician tell me that I owed more because their fee schedule was above the approved insurance compnay schedule.  Perhaps others here have had different experiences and find this practice acceptable.  I just don't think this is right.

Tudpock

Crew,

I also know of one doctor at Henry Ford Hospital, Dr. Mani Menon of Detroit, that wants cash up front based on your ability to pay. The surgery part is not covered by insurance according to his staff.

Wow, sounds like a scam to me. As I understand it, when a doctor or hospital agrees to accept payment from an insurance company it is at a negotiated rate period. You will sometimes find a doctor who chooses not to participate with a particular insurance company. In that case you generally pay the doctor yourself and then file an out-of-network claim and the insurance company pays you based on their rate for the treatment not on the bill.
But who knows, perhaps your insurance company does permit this sort of thing.

Ask your health insurer if code CPT 55866 is covered.  That seems to be the standard coding today, see, e.g., http://www.bcbsms.com/com/bcbsms/apps/PolicySearch/views/ViewPolicy.php?&blank&action=viewPolicy&noprint=yes&path=%2Fpolicy%2Femed%2FRobotically_Assisted_Laparo_Rad_Prostatectomy.html&keywords=%3C!123-321!%3E&source=emed&page=id=200&me=index.php

Greg

BTW, at the time of my surgery, I had BlueCross Blue Shield of South Carolina, and they would have had no problem paying for the robotic if that had been my choice, would have been done by the same urology practice and the same local hospital.

I thought you might be interested in my Canadian experience. Our health care is administered by our provincial (state) governments. I wanted to go to another province to have the daVinci. My home province paid all medical costs for the surgeon and hospital, except $25 I paid for one night in what turned out to be a private room. I didn't need to be referred by my doctor. I was able to hunt out this guy on my own. In addition I saw two urological surgeons in my own city to get their thoughts and advice and had my slides read twice by two different pathology groups, again all paid for. I was not considered to be a 'rush' case --- my urologist said if I wanted to golf for the summer and be done in the fall he'd have a hard time making a case that I'd be any worse off --- and yet I had OR time booked about four weeks after seeing the surgeon.

I don't claim this is better, worse, or just as good as private insurance plans in the U.S. I simply post as I thought others might be interested as to how it worked in Canada ---- at least, how it worked for me.

Sheldon AKA Sleepless

Mavica - I agree with your sentiments, there does seem to be a "witch hunt' attitude among some that doctors are evil and wrong and don't know what they are doing. I feel the opposite for the most part, and thankful to live in a land where there are so many good doctors and medical options if needed.

Sheldon - your Canadian choices sound good to me, better than many us Yanks have, even with health insurance. There are a lot of stereotypes of how terrible it is in Canada, glad you spoke up about it. I have had other Canadian PC brothers tell the same stories as yours.

David in SC

This reply is to crew, who posted about Dr. Mani Menon. I personally just got back home (Orlando) from a two day interview trip with Dr. Menon and his staff. I have decided the way to address my PC is with da Vinci surgery. Dr. Menon is recognized in this field as one of the top 5 in the world. Some of the other top surgeons listed on other blogs I found have either trained under, been mentored by or corroborate with Dr. Menon. My thought was why go to the student when I could meet with the teacher.

As to the postings about cash up front, verifying income and so forth. All Dr.s have the right to opt out of Insurance programs and not participate with them. Dr. Menon some years ago opted out of Blue Cross/Blue Shield and Medicare. When meeting with patients covered by those insurances he does everything he can to work with them. He has a sliding scale of his rates to assist those with lesser insurance coverages and has done hundreds of surgeries at no cost, based on situations and needs.

My insurance is very good coverage. Not only is Dr. Menon, the Vattikuti Institute and Henry Ford Medical Complex in network for me, but, my insurance even covers my travel and living accommodations. To show their gratitude to patients that travel from outside their comfort zone of home town Dr.s to be treated by Dr. Menon, they cover the first $500 of living expenses for the patient. Staying on campus at the Clara Ford apartments ( a scant 75 yards from the hospital), a 1 bedroom, completely furnished and equipped apartment is $69 per day (taxes included). So my 10 day stay of $690 will only cost me $190 out of pocket until I am reimbursed by my insurance company.

I felt it important to provide this information because a lot of us PC folks are out there trying to find answers and make decisions and having a few non complete posts only confuses them. There may be some that would greatly benefit from being treated by Dr. Menon who would not take the first step because of these inaccurate and incomplete posts.

Good point, Sheldon, on both the education issue and the hunger. Hungry children have no boundaries, that's for sure.

For older Americans, us in our 50's and above, we grew up with Communisim is bad, Socialism is bad, etc. etc. So anything that can be labeled as socialism or socialized is deemed bad, regardless of merit.

In a nation as wealthy as ours, the USA, its a shame that to get good medical care, you either have to be rich on your own, have fantastic but expensive health insurance, or be so poor the govt pays for anyway. If you aren't in one of those categories, you aren't going to get the time of day out of most doctors and medical facilities. I have generally always been treated well over the years, but then I have always had good health coverage when my maladies struck.

Regardless, both Americans and Canadians have outstanding options available, compared to the majority of the world's other countries. For that, personally, I am thankful I was born here.

David in SC

Last February I had robotic surgery at Florida Hospital in Celebration near Orlando, Fl with Dr. Vipul Patel. Dr Patel could be the No.1 robotic surgeon for prostate surgery in the world. I was pre qualified with Blue Cross/Blue Shield. The total came to about $32,000 for everything. Being the begining of the year, I had to pay the full $1000 deductable out of pocket.  

Sam