MONEY AN ISSUE? INSURANCE AN ISSUE?...previously posted by Bev.

From: Helen Dynda (
Mon Mar 12 22:09:15 2001

On May 20, 2000, Beverly Doucette wrote:


Because insurance companies across the USA have set rates ( ceiling rates ) on most surgical procedures, they set a rate for that procedure based on what they think it SHOULD cost. So in a normal "Adhesiolysis" procedure, the usual rate across the board is about $2500 total! That means that no matter who the surgeon is or the facility where it is performed, the insurance company will pay NO MORE than that matter how long the procedure matter how skilled the surgeon is... or what the reputation of the surgeon is. That is the amount they will pay; because that is what they feel that particular surgery should cost. That rate is based on the amount of time and the "importance" of the adhesiolysis procedure.

Most insurance companies feel that an adhesiolysis procedure SHOULD be able to be performed in about 1.5 to 2 hours...TOPS!!! Why? Well, as you know, MOST surgeons and Drs. DO NOT feel that adhesions in and of themselves are a disease or cause a problem...unless you obstruct. So it is their impression that a surgeon should be able to go in, via a laparotomy or laparoscopically, and simply slice the adhesions apart.

They also feel that an adhesiolysis should be or is usually done in relationship to a cooperative surgery... such as a hysterectomy, appendectomy or some other type of surgical procedure. If you look and listen to other ARD sufferers, there has always been another reason or procedure done, when they had an adhesiolysis. Do you know why? Because the surgeon gets more money by performing another procedure with the adhesiolysis!!

When they do a "diagnostic" procedure ( which is their way of being able to perform an adhesiolysis only ) they get paid very low rates for their time...and adhesions take time!! So most Drs. do the 1.5 to 2 hour adhesiolysis and then close you up...or take out an organ...or do a resection, etc.!! Not only will they NOT do a good job; but the hospital will NOT allow any more time for an adhesiolysis...because the money paid to the hospital from the insurance companies is not enough to compensate for the use of the operating room, the anesthesiologist's time, etc. So everyone loses...mostly the ARD patient!!"

By asking for the down payment up front at Community Medical Center at Scranton ( PA ) this assures that -- in the event the insurance company doesn't pay for a lengthy adhesiolysis procedure -- then Dr. Redan or Dr. Reich have at least been compensated for their time, skill, and expertise in lysing adhesions. If you're very involved with adhesions and the surgery takes 4 to 10 hours, trust me...the insurance company will NOT pay for that!!

If your surgery is within a "normal" range of time and all the pre-payment is not utilized, you will get all or some of it back. I had a 5 hour surgery and was refunded a decent portion of it after my surgery! The $400 consultation fee is what you pay for the experienced specialist, if you want them. A person wouldn't think twice, if you were talking open heart surgery. You would go to and pay for the best Dr. in the world, if it meant your life, right? Well this is your life too!! It is just that it is under-rated as a problem...unless you're the victim of ARD Adhesion-Related Disease )!! Money spent is scary to be sure; but money is nothing without the life to spend it.

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