-----Original Message----- From: Jean (from PA) [SMTP:creative@enter.net] Sent: Sunday, February 25, 2001 10:48 PM To: Multiple recipients of list ADHESIONS Subject: Re: My letter to: JEAN from Pennsylvania about Dr. Redan....
At Sun, 25 Feb 2001, Mary Wade wrote:
>
>Jean--Something in your letter struck me as "Ut oh....think we have to
>figure this out." It was your comment that "I am just hoping since there
>aren't procedure codes (as I have heard
>>from some people) for the operation that my insurance doesn't refuse to
>>pay anything." that has me concerned and confused. This was not my
>experience with Dr. Reich and Redan. There WERE procedure codes for the
>procedures that they did. Could you clarify on this point? Thanks. Your
>friend, Mary
Hi Mary, I had asked my insurance company awhile back if they could tell me if and how much they would cover for Adhesion Lysis. They said I needed to get a diagnosis code and procedure code in order for them to know if and what they would cover. I told this to Sue but she didn't supply me with any codes so I could check on my coverage. I didn't think that would be so difficult since I assumed there was "a code" just for adhesions in general....am I wrong?? I know of others who had difficulty getting codes from Sue also. I don't mean to be picky or anything, just reassured.
I hope you understand why I am worried about this.....after what my insurance is pulling off with the nursing home. I thought after all the appeals and changes in codes from the nursing home that the insurance would have paid them by now. Can you imagine the 6 week bill for intravenous antibiotics and therapy, let alone room and food etc.?
It is also largely the fault of the insurance company that I am out of the $900 from another doctor. "They" had the wrong ID number for the doctor when they told me I had to pay him cause he wasn't in-network. I sent the doctor the small "out-of-network" amount I received PLUS I scraped allot of additional money together( a portion of the charge)and sent it to the doctor and then it was discovered he was "in-network". The insurance then sent the doctor "all of" the "in-network" payment instead of deducting what they were already paid from me "out-of-network" from the payment. The insurance then told me "I" owed the insurance company their money back and "I" had to get my money back from the doctor although I don't have it and "told them" it was all sent to the doctor! They made me pay them back... so now I paid the doctor, they paid the doctor AND I also paid the insurance company. Then I even hire and pay a lawyer cause the doctor won't return my money and they still won't reimburse me! What a mess, and I just keep losing more money!!
I figured I was in good shape with the Scranton hospital cause they do participate with my insurance....but now I am not sure. Am I worrying for nothing? Does the insurance "have to pay" if the hospital is participating (in-network)??? Are they "obligated to pay something" towards the doctor bill if they are out of network??
Every time I start feeling really good about going there for the surgery something in my life backfires in my face to cause me to worry a again. Appeals and lawyers haven't worked for me! I also really thought my MD would help by writing a referral letter, but I was wrong. If this other surgeon heard of them maybe he will write one?? The doctors around here aren't very willing to help you. I just figured it "might" help in-case the insurance would say something like "you should (or must) go to a doctor who is in-network".
Thanks for being a compassionate & understanding friend. Sorry this is so long....I get carried away. JEAN
>
>At 12:52 AM 2/25/01 -0600, you wrote:
>>At Sat, 24 Feb 2001, Helen Dynda wrote:
>>>
>>>Jean ( creative@enter.net ) from Pennsylvania said: "I asked my MD to
write
>>>a referral paper for Dr. Redan cause even though I don't need referrals
I
>>>read on here that it may help prevent insurance problems. He refused,
since
>>>he never heard of them.
>>>
>>>~ ~ ~ ~
>>>
>>>Dear Jean, I am so sorry to hear that your doctor refused to give you a
>>>referral to Dr. Redan.
>>>
>>>You might ask your doctor if he has ever heard of Dr. Harry Reich. Dr.
>>>Reich is "the most talented laparoscopic surgeon in the world!!" Dr.
Reich
>>>performs surgery at both Community Memorial Hospital ( CMC ) in
Scranton, PA
>>>and at St. Vincents' Hospital in New York City. Since you are from
>>>Pennsylvania, surely your doctor has heard of Dr. Reich.
>>>
>>>In April 1999, Dr. Reich performed a successful adhesiolysis procedure
for
>>>Deb. I saw Deb's video -- her abdominal and pelvic organs were
completely
>>>covered with adhesions!!. It took Dr. Reich 10 hours to complete Deb's
>>>surgery!!! Deb is pain free today!!
>>>
>>>For a long time Dr. Reich realized that postsurgical adhesions have been
>>>causing so many people problems with chronic pain, infertility, bowel
>>>obstructions, etc. Since he had been experiencing success with his
>>>adhesiolysis procedures, Dr. Reich made a decision to specialize in
>>>performing adhesiolysis procedures. Since Dr. Reich's specialty is
Ob/Gyn,
>>>he needed to find a General Surgeon to be his surgical partner. It was
then
>>>that Dr. Reich personally chose Dr. Jay Redan to be his surgical
partner.
>>>Dr. Redan is a very skilled and experienced laparoscopic surgeon too.
>>>
>>>On May 1, 2000 these two surgeons opened the very first Adhesions Unit
in
>>>the United States at CMC. Since then Dr. Reich has been working very
>>>closely with Dr. Redan -- at both CMC and St. Vincents Hospital --
>>>specializing in adhesiolysis procedures.
>>>
>>>When adhesion involvement is very severe, such as in Deb's case, it is
>>>extremely important that the surgeon is very meticulous as well as
extremely
>>>cautious as he lyses adhesions...for the safety of the patient and to
give
>>>the patient the very best chance to become pain free. The surgeon must
be
>>>sure that there is NO blood or other debris ( such as talc from the
>>>surgeon's gloves, lint from sponges, etc.) left in the abdominal cavity.
He
>>>must also be very careful so that he does not traumatize internal
organs.
>>>All of this takes time...a lot of time, if the lysis of adhesions is
going
>>>to be a success!!
>>>
>>>When a surgeon tries to complete an adhesiolysis procedure in a maximum
of
>>>1-2 hours, the surgeon's decision -- to complete the adhesiolysis
procedure
>>>within this time frame -- does NOT show consideration for the safety and
>>>well-being of the patient. Chances are the surgeon is "rushing" the
>>>adhesiolysis procedure simply because he knows that an adhesiolysis
>>>procedure is the "most underpaid" surgical procedure that Medicare and
other
>>>insurance companies reimburse the surgeon for.!!!!!!!
>>
>>Helen,
>>Thanks for your response to my post.
>>I think I also mentioned Dr. Reich to my MD, but not sure.
>>I will ask the general surgeon when I go, if I am lucky maybe he will
>>know one of them.
>>
>>I know exactly what you mean about the rushing etc.
>>I do believe what you say about Dr. Reich.
>>I definitely prefer someone who cares and is gentle!!
>>
>>I am just hoping since there aren't procedure codes (as I have heard
>>from some people) for the operation that my insurance doesn't refuse to
>>pay anything. I definitely can't afford to pay the entire doctor bill
>>AND the hospital. I would go out of network and don't know if they
>>would definitely be required to pay?!? When I asked for codes Sue
>>couldn't give me any so I could check with my insurance. The insurance
>>said I need diagnosis codes and procedure codes to see if it qualifies
>>and for how much.
>>
>>I do already have a problem going on right now with the insurance
>>refusing to pay for my nursing home care of 6 weeks (big time money).
>>The nursing home has appealed it about 6 times now in 7 months time.
>>The insurance company was the one who said they would only pay for my 4
>>weeks of intravenous "if I was in a nursing home", but not as an
>>out-patient with a visiting nurse coming in to start & stop it twice a
>>day so I had no choice. The nursing home "is a participating facility"
>>so it is in-network.
>>These HMO's are something else!!! I know they definitely are not in
>>business to do anyone any favors and will do whatever it takes to get
>>out of paying if possible.
>>
>>I also never got my money back ($900) from that doctor who double-billed
>>(me & the insurance) even after I got a lawyer.
>>He couldn't believe it either....my kind of luck!
>>
>>Hope you are still feeling good.
>>JEAN
>>
>>--
>>Jean (from PA)
>>
-- Jean (from PA)