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rohrer01
04-29-2010, 11:41 PM
I have been doing some research on which doctor to get a second opinion from and have narrowed it down to Dr. Lonner and Dr. Lenke. They are the ones I hear the most about. I am impressed with Dr. Lonner's up-to-date knowledge of minimally invasive procedures. I am impressed that BOTH doctors put up patient testimonials with before and after X-rays. I will say that it looks as though Dr. Lonner gets better corrections in curvatures than Lenke, but Lenke is also doing surgery on some pretty seasoned people (how do you say "old" with political correctness?) with previous surgeries, broken Harrington's etc.. At least the man isn't afraid to tackle the challenge. As I think of my experience with Dr. Tribus, he has no such testimonials or before and after's on his website.

My only problem is how to pay for it. I have had many people suggest to me to try to get SSI for chronic pain. Then I can get medicare and get the surgery from a surgeon of my choice. I just feel guilty doing it. I know my pain is disabling, but I see so many of you with worse deformities working that I have a hard time justifying it in my mind. Any thoughts on that would be great, too. Don't worry, my feeling won't be hurt if you think I'm nuts for considering it. I just don't know how we could ever pay for a surgery like that. There is no way on Earth that my insurance would pay for me to go to NYC for an operation like that.

I have traveled out of state to go to the best female reconstructive surgeon, I believe in the country, if not the world. I had the money then to pay for it, but it was cheap, only $6000 for EVERYTHING including motel and airfare and the surgery. Now I'm broke. My house isn't even worth as much as the surgery would cost, so I can't even go that route.

I'm also having a VERY bad pain day.I have days like this pretty often and I know it would be very difficult to hold down a job unless I was self-employed. Nothing has helped me today. I can barely function (no housework at all - I feel guilty putting it all on my family), my neck hurts, my ribs hurt, my spine itself hurts, I didn't even take my walk todsy. Oh wait! It's not scoliosis related! LOL:eek: I'm just being catty. sorry. Any input on Dr. Lonner or SSI would be greatly appreciated. Thanks in advance. Maybe he would let us make payments????

jrnyc
04-29-2010, 11:54 PM
Oh, rohr..i am so sorry that you are having so much pain lately!
i love Dr Lonner...i have seen him for about 5 years as he follows my curves...he's been recommending surgery to me for at least 3...but now, this time, it is minimal invasive...

so, you dont have insurance,huh...is that what you are dealing with? i carry the insurance i had before i retired, but pay waaay more for it now...i also have Medicare as of a year ago...however...and this is a big however...lots of doctors do not take Medicare!!! and i havent switched to one of those "Medicare Advantage" plans, cause i have doctors who dont take that either! thus, i just hold onto my HMO insurance that i carried before i retired 3 years ago...i dont even know why i pay for Medicare...i think i used it once...Dr Neuwirth takes it...at Beth Israel Hosp in NYC..i liked him...saw him a year ago...dont know if he is doing minimal now or not...but i just liked Dr Lonner more....there are a few people i've seen on forum who had Dr Neuwirth for surgery and liked him...plus he wrote one of the scoli books!
disability is definitely get-able..as far as i am concerned, i filed when i had to retire due to the pain...went from working 2 jobs...and paying social security for both...to not working at all...

jess

rohrer01
04-30-2010, 12:08 AM
Oh, rohr..i am so sorry that you are having so much pain lately!
i love Dr Lonner...i have seen him for about 5 years as he follows my curves...he's been recommending surgery to me for at least 3...but now, this time, it is minimal invasive...

so, you dont have insurance,huh...is that what you are dealing with? i carry the insurance i had before i retired, but pay waaay more for it now...i also have Medicare as of a year ago...however...and this is a big however...lots of doctors do not take Medicare!!! and i havent switched to one of those "Medicare Advantage" plans, cause i have doctors who dont take that either! thus, i just hold onto my HMO insurance that i carried before i retired 3 years ago...i dont even know why i pay for Medicare...i think i used it once...Dr Neuwirth takes it...at Beth Israel Hosp in NYC..i liked him...saw him a year ago...dont know if he is doing minimal now or not...but i just liked Dr Lonner more....there are a few people i've seen on forum who had Dr Neuwirth for surgery and liked him...plus he wrote one of the scoli books!
disability is definitely get-able..as far as i am concerned, i filed when i had to retire due to the pain...went from working 2 jobs...and paying social security for both...to not working at all...

jess

It's not that I don't have insurance. My hubby and I pay $680 a month for our insurance. They are an HMO and I had to go before a board of doctors to fight just to get to see Dr. Tribus. I doubt that they will ever approve me again, especially for a second opinion where they may have to pay for the surgery! Dr. Tribus is "in-state" at least. I would have to travel to see Dr. Lonner. Maybe if I call his office and explain the situation, they would set up a payment plan or something...who knows. I can't get disability because I haven't worked. I've always been a stay at home mom. And when I did work, it never lasted more than a couple of months because of the pain. I end up having to quit. So I went to school and got a very employable degree, so I thought, but they find out I have lifting restrictions and my age, 41, no one will hire me. Like I said in an earlier post, my husband doesn't want me to work - he is protective because of my back. Some days I get really mad at him, but others, when I spend the night crying in pain, I thank him. So I don't really know what to do there. My mom is on medicare - she's retired- and has found that most doctors do take her insurance. She bought all the expensive suppliments, though. She gets VERY little money in social security.

Applying for SSI is a long process as well. I'm sure it would take a year or more, and in the meanwhile I stay on drugs??? I wish it didn't have to be so hard. I wish more scoli doctors were more understanding. But that's the dog-eat-dog world we live in I suppose.

Here it is, late once again and my meds never kicked in. I will be awake until 2:00 am waiting until I can take another dose and hopefully go to sleep. It's aweful!! Thanks for listening!

joyfull
04-30-2010, 05:52 PM
I don't have an HMO, but if you pay the travel and hotel expenses, perhaps they would consider paying for the surgery. This may be naive, but if Dr. Lonner or Lenke writes to them saying that you really need this surgery, could that make a difference? Have they ever done this before? It may pay to travel for a consultation and pay out of pocket if there is a chance they will pay.

rohrer01
04-30-2010, 08:13 PM
I don't have an HMO, but if you pay the travel and hotel expenses, perhaps they would consider paying for the surgery. This may be naive, but if Dr. Lonner or Lenke writes to them saying that you really need this surgery, could that make a difference? Have they ever done this before? It may pay to travel for a consultation and pay out of pocket if there is a chance they will pay.

I thought about that. Letters from doctor's who say I need the surgery would definitely influence the head of neurosurgery, who is calling all the insurance shots. "The Insurance Company" takes his word as final. He already thinks I need the surgery, so I don't think it would be hard to convince him. It's just I don't know if they (the insurance company) will pay out-of-state. I need to look into it. I have the feeling that the insurance company will just state that Dr. Tribus has already seen me and has the expertise to handle surgery and doesn't feel that I need it at this time and that will be the end of it. That's a big reason why I'm thinking about applying for SSI. I wish the insurance companies would just let you see whomever we want. I don't like not having a say over my own healthcare. If it came down to it. I suppose we could cancel the insurance and make $600/mo payments toward a loan for the surgery? It sounds like a BAD idea to me, but I'm desperate. I'm sure something will come up. I really do need a second and third opinion after what I found out today. :(

jrnyc
04-30-2010, 09:22 PM
rohr...they should not be able to refuse a second opinion when insurance companies used to require 2nd opinions before they would OK surgery at all...
i dont understand the objections to out of state doctors...it is not as if the insurance pays hotel and travel expenses!! doesnt make sense, and so unfair!!

i dont have alot of money, but paid for at least 2 opinions cash out of pocket...it makes me feel better to know that other scoli surgeons with excellent reputations agree with the decision and the area to be fused!

jess

rohrer01
05-01-2010, 07:36 AM
rohr...they should not be able to refuse a second opinion when insurance companies used to require 2nd opinions before they would OK surgery at all...
i dont understand the objections to out of state doctors...it is not as if the insurance pays hotel and travel expenses!! doesnt make sense, and so unfair!!

i dont have alot of money, but paid for at least 2 opinions cash out of pocket...it makes me feel better to know that other scoli surgeons with excellent reputations agree with the decision and the area to be fused!

jess
I just really need to think long and hard about who to go see. Travel expenses can really add up, and I don't travel so well, especially by car. I swell up in the ankles really bad. Flying just terrifies me, especially to NYC. I'm still looking and thinking. Dr. Lenke isn't really THAT far. He's in Missouri, right? But he doesn't advertise minimally invasive. I looked at the Mayo Website because they "advertise" for adults, but can't find anything for adults on the website. If I could go there, it's only a couple of hour drive. I've already been seen by a doc at Twin Cities Spine Center 12 years ago. The doctor wasn't very nice. I was in excruciating pain and he had an attitude like Dr. Tribus. He told me to take some Tylenol. What a joke. I understand no surgery then, I was only 41* and not progressing (only 2* since diagnosis).

I need to find someone who I will feel comfortable with. Even if surgery is NOT recommended, I want them to be able to tell me what next step to take, not just callously leave the room with NO advice. I don't know why I have always had such unempathetic doctors! It's the story of my life! Maybe it's the way I come across to them. It's not like I sit in the office and whine and complain. I just explain the situation. They just seem more interested at looking at the X-rays. Dr. Tribus didn't even examine me at all the last two times. The doctors usually put you in a gown and actually look at your curve in REAL life and how you can move and bend. He had his assistants do a quick lame exam. Barely even looked at my spine, and definitely not my bare back, which I think is important. I wear clothing that downplay my curves, so of course it doesn't look like much. But when you look without a shirt, it's a whole different story.

Anyway to make a short story long. I need my other opinions to be people I think I will feel comfortable with, no matter what they say surgically. Dr. Lonner appears to be on the same page. Too bad he has to be in NYC. That place frightens me. I have NEVER even wanted to visit there. A friend of the family has a sister that lives in New York State that isn't that far, I guess from the city. We almost went this month. The only reason I was excited is because my hubby was going to take me to Nantucket Island. Maybe we could still take that trip and just include a Dr. visit in with it. :p

rohrer01
05-01-2010, 07:38 AM
Here's maybe a dumb question. Would I get a copy of my X-rays from Dr. Tribus on disk so they won't have to take any more, or will they want their own?

foofer
05-01-2010, 09:07 AM
I brought a copy of my x-ray via disc taken from Oct 08 to Dr Boachie's office in Jan 09. He was unable to read the disc and kept it for awhile to have someone try to switch it to an appl they could read. It was sent back a few months later, but I don't think it was ever read. So you save the radiation but risk that their systems do not work in sync. The next time I went to Dr B, he took his own x-rays, and my curves were 8 degrees more per curve according to his measurements, in 10 months. He said it might be the difference between the system of measurement and not progression. We will find out next time I go in the fall.

jrnyc
05-02-2010, 06:09 PM
hey rohr
i heard that dr lenke has a 10 month waiting list...i think you'd have to call now to get in sometime next year!
dr lonner is not as long a wait..he takes his own Xrays...
as a born and raised New Yorker, it is hard to understand why folks fear NYC...i guess it's the same reason that i'm scared of crickets n' country stuff!

jess

Back-out
05-02-2010, 07:46 PM
Dr. Lenke is about to assume presidency of the NSF as of Sept of this year. Because of how much this will add to his work load among other things, he is only accepting "the most extreme curves". E.g., my curve of 60 Deg (L) is considered too trivial per se. Yours, rohrer , would he "invisible" to him according to his present cut off! :(

As for Dr. Neuwirth's insurance, he does NOT accept MEDICARE unless he is following up a patient he treated on a prior insurance plan. I asked in mid March and that's what I heard. He had a few choice words for MEDICARE reimbursement, which objectively, I CAN understand but it is still disturbing.

I thought this was differently reported on this thread but perhaps it was a different one.

jrnyc
05-02-2010, 08:39 PM
Wow...i saw Dr Neuwirth in Nov 09...he took my Medicare...at least the hospital did...i have another insurance...private...but they wanted to use my Medicare instead...which is strange, since i know their hospital (Beth Israel, where his office was) takes my other insurance!

i dont understand...is Dr Lenke going to become president ...of what...?? of the foundation? is that what NSF stands for...why would that prevent him from operating...and i think calling 60 degree curves trivial is ridiculous for ANYONE, doctor or not! maybe call them not severe enuf...but in no way in ANYONE's book are they trivial...ask any of the doctors operating on them!! furthermore, if ANY DOCTOR on this forum EVER referred to a 60 degree curve as trivial, i'd stop reading this forum!! i'm so impressed that he is only operating on "EXTREME" curves....Dr Boachie operates on "extreme" curves but he still operates on "trivial" ones like mine! far as i'm concerned, Dr Lenke is abandoning patients!

jess

Back-out
05-02-2010, 09:14 PM
Maybe Dr. Neuwirth changed his mind, jess or else maybe he just wanted to encourage me to have my surgery before my insurance changes!

About Dr Lenke - neither he nor anyone there referred to my curve (which is lumbar besides) as "Trivial" . Rather they said it "wasn't extreme enough". I guess he is trying to reduce his patient load (now, especially) without refusing insurance plans like Dr. Boachie - and others - do.

Also, it's possible he is most interested in the added challenge of correcting extreme curves. Then too, with his expertise, maybe he feels he can make the most contribution in such cases (which many other doctors refuse). Lastly. the worse off the patent is, the more assured he can be of gratitude and making a positive improvement.

To put myself in his position!

As for why the presidency of the NSF (yes, THE foundation) should be time-consuming - ha, Just think! He is already heavily into academic research and paper writing, and such a leadership position is far from that of a figurehead. He'd have to fly to extra meetings and presentations all the time, especially while he's setting up shop. University heads and foundation presidencies involve a tremendous amount of organizational paperwork too, even with delegating and staff support.

I'm afraid the bottom line is that the Foundation's gain is the loss of his prospective patients for the nonce. Even HE has only 24 hours in the day.

A friend of mine who is a top doctor (and so are his sons - researchers and administrators, in addition to running a clinical practice), particularly warned me to be very wary about choosing a surgeon with a prestigious position. Many dedicated doctors avoid them because they are so demanding and limit their ability to "Be there" for their patients. My friend also warned me that often such honorifics are just that, and don't reflect greater expertise or clinical prowess.

It has been my experience (in the past, I've needed to search out highly skilled specialists in other areas) that it's definitely a mixed bag. Some doctors are expert self-promoters and that's the root of such dubious promotions. Others, though, are excellent physicians as well as holding a specialty office like this for a year.

Dr Lenke is certainly in the latter category, but that doesn't mean that he won't have to limit his clinical practice for the upcoming year! And face it, if he accepted all comers, he'd have a waiting list five years out! There has to be some triage - financial or by condition.

He sounds like a workaholic already, and I'm sure he will approach this position with the utmost dedication. His staff told me he might even have to cancel (Postpone, I assume) scheduled surgeries if he "got a call" - meaning something to do with the Foundation.

God forbid he should just keel over from over-work!

Back-out
05-02-2010, 09:22 PM
BTW what 's most remarkable about Dr Lenke's being elected to this position, is his relative youth. They tend to go to Senior practitioners as a recognition of their contributions before they take their bow (kind of like the Academy Awards). There's a lot of politics involved. Dr Lenke is "only" 49.

jrnyc
05-02-2010, 10:15 PM
i cant stand hearing about brilliant doctors.....if they abandon the "ordinary" patient...like me...and others...then they are of no use to me...and no use to many many others...let them go back to the lab or the think tanks...Dr Boachie operates on poor people in Africa...extreme, extreme curves...that is what i respect...Dr Lonner goes to Ghana and does the same.....that dedication is what i respect...
i dont even want to say here what i think of the change Dr Lenke will make...that is his choice...but i dont have to be impressed with it, or with the "extemity" of the curves he will now consider acceptable.

i see doctors like Boachie and Lonner operating on VERY extreme curves.....they are not abandoning patients...maybe they will go more into research or education when they are older or when their hands are no longer as steady......but for now, they continue to operate on their patients...check out their websites...so i Am Not Impressed with what Dr Lenke will do or refuse to do in the near future...

does every doctor who "accepts his bow" at the Foundation have to give up patients with curves that are "not acceptable" to them? people who are accepted for the surgery are in need of the surgery...surgeons make darn sure of that...as witness complaints on this forum...so i dont see how Dr Lenke would be accepting "all comers" if he continued accepting those "not extreme enough" curves like 60 degrees....

jess

Back-out
05-02-2010, 11:36 PM
Jess, I think you missed my point about the need for triage. What good is it, if a doctor continues to be there - for the highest bidder? I prefer a surgeon who sets a standard of condition (not finances), especially if it's where he feels he can do the most good.

What good is to me if Dr. Boachie accepts everyone who can self pay a 150K surgery (only the surgeon's fee!) - which happens to satisfy the dual purpose of enriching him and reducing his patient load to where he wants it? I respect Dr. Lenke more. He could charge what the market will bear like Boachie to reduce his unmanageable load, and chooses not to.


And by the same token, what good is it to me (or most sufferers) to be nominally "accepted" into his practice only to have to wait five or more years? Those of us with rapidly progressing curves would already be untreatable - or dead - by the time he got to us!

jrnyc
05-03-2010, 12:06 AM
as far as i know, Dr Boachie takes "assignment," so if one has insurance, he will accept what the insurance pays...i was just unlucky in that i have to go in network...so i couldnt have him as my surgeon...but then it worked out better for me because i like Dr Lonner better, always have, and not only does he take my insurance, but he now will do minimal invasive on me...havent heard of Boachie doing that..

i never said Dr Lenke should operate on everyone...just that it shouldnt require a 100+ curve to get his attention...and as far as i have heard, once a patient waits for the opening to be seen for consult, they are in for surgery...the consult wait is not 5 years, but 10 months or so...

i have never cared for "exclusive" doctors...exclusive in any way...in terms of finance or condition!

Dr Lenke can do whatever he wants...again, i dont have to be impressed by it...i am far more impressed with doctors in the field, working for the good of all those suffering...there is no such thing as someone with a 60 or 70 degree curve not suffering enough!

jess

Doodles
05-03-2010, 01:52 PM
Jess--
Personally, I'm glad there are doctors who specialize in the most difficult cases. When others can't or won't do it or don't have the confidence to do it, I'm glad there are the Dr. Lenke's. Another perspective--I had meant to post this anyway. When I went for my check-up in April, my sister-in-law gave me a copy of the SL Post-Dispatch. Had a big article about doctors in SL doing pro bono work for foreign children--more than anywhere in US. Dr. Lenke was one of the main featured doctors. Here are a couple paragraphs:
Dr. Lawrence Lenke performs surgery for no pay on an international child about every two to three months. "That's why I became a doctor," he said.
Lenke said it was getting harder to persuade hospitals to accept chairty cases. His waiting list which can reach up to 12 months, includes seven children without ability to pay.
"I want to help more of these kids, but we are limited in the financial real," he said.
Even if doctors donate their services, hospitals have to pay for the nursing and support staff, etc. etc. etc.

It features a 14 year old who has had scoliosis surgery from Lenke and how they live with a host family. It talks about other surgeons also. The article is from 4/11/10. You could probably Google it. Janet

jrnyc
05-03-2010, 02:20 PM
i'd like to know how people would feel if they needed heart surgery but the surgeon said they werent sick enough...?

i am so grateful the the surgeons like Dr Boachie and Dr Lonner who operate on SEVERE curves of over 90 degrees but still see the little people like me...i do not wish to wait til i reach the 90 degree mark on my lumbar curve...which i am sure i will get to if i do nothing...to see the great Dr Lenke...

i'd hate to hear a cancer surgeon tell a patient that their tumor isnt big enough yet....

but that's just my opinion

jess

loves to skate
05-03-2010, 02:57 PM
Dr. Lenke is about to assume presidency of the NSF as of Sept of this year.

Are you sure about this? Joseph O'Brien is president of the NSF and as far as I know, he is not a doctor. Could it possibly be the presidency of the SRS?
Just wondering.
Sally

Back-out
05-03-2010, 03:07 PM
Are you sure about this? Joseph O'Brien is president of the NSF and as far as I know, he is not a doctor. Could it possibly be the presidency of the SRS?
Just wondering.
Sally

Quite right! I meant the medical foundation. I am only now realizing the difference! :o

Back-out
05-03-2010, 03:21 PM
Jess, Dr. Boachie wouldn't see me because my insurance wasn't good enough, In fact, I spoke more than once to their special insurance rep who said some hurtful things about my insurance plan - the best I can purchase in PA as a private individual (and not cheap). Others apologized for her but she is obviously senior to them.

You may have found if you investigated it, that "takes assignment" means only that he accepts what your company will pay and then counter bills you for the remainder.

That is likely to mean you find yourself with an out of pocket cost of 150K (what I was told to expect). And aside from the hospital, there is the little discussed issue of the anesthesiologist's fees - very high naturally for this very lengthy operation. These too are not covered by many/most plans and the patient can be left paying most of them too (av. $11K also per same patient rep).

He officially accepts no insurance but will condescend to accept the out of network benefit ones insurance pays PLUS the "balance billing" , As for MEDICARE - that's beyond the pale!

His privilege, of course! And as I said, he needs to thin out his patient demand, He could never take everyone who wants him as their surgeon. So he charges what the market will bear. So do many/most of the HSS surgeons.

They wouldn't even let me see him for a consult - for information - regardless of whether I paid out of pocket ($450+ "depending on complexity"), I was told he had changed his policy. He doesn't want to "waste his time" seeing someone who already knows in advance they could not afford to go through with surgery, using him as their surgeon.

jrnyc
05-03-2010, 03:28 PM
i posted this note and somehow it disappeared...

wellll...now i understand what would take up his time and require him to reduce his caseload......cause i didnt think the Foundation would be that time intensive and couldnt understand why a surgeon would be in charge when it is currently someone without an MD.....

i still thank goodnes for doctors like Dr Boachie and Dr Lonner...who operate on large and larger curves...

jess

jrnyc
05-03-2010, 03:32 PM
as far as i know and all the surgeons i've experienced, "takes assignment" means the patient wont owe once the insurance pays whatever it pays...so obviously, he is not taking assignment if he is billing for the rest in cash...there are a few patients on forum who had surgery with Dr Boachie...would be curious to know what they had to deal with concerning insurance, but it is their right not to reveal it here...

jess

rohrer01
05-03-2010, 03:45 PM
Jess, Dr. Boachie wouldn't see me because my insurance wasn't good enough, In fact, I spoke more than once to their special insurance rep who said some hurtful things about my insurance plan - the best I can purchase in PA as a private individual (and not cheap). Others apologized for her but she is obviously senior to them.

You may have found if you investigated it, that "takes assignment" means only that he accepts what your company will pay and then counter bills you for the remainder.

That is likely to mean you find yourself with an out of pocket cost of 150K (what I was told to expect). And aside from the hospital, there is the little discussed issue of the anesthesiologist's fees - very high naturally for this very lengthy operation. These too are not covered by many/most plans and the patient can be left paying most of them too (av. $11K also per same patient rep).

He officially accepts no insurance but will condescend to accept the out of network benefit ones insurance pays PLUS the "balance billing" , As for MEDICARE - that's beyond the pale!

His privilege, of course! And as I said, he needs to thin out his patient demand, He could never take everyone who wants him as their surgeon. So he charges what the market will bear. So do many/most of the HSS surgeons.

They wouldn't even let me see him for a consult - for information - regardless of whether I paid out of pocket ($450+ "depending on complexity"), I was told he had changed his policy. He doesn't want to "waste his time" seeing someone who already knows in advance they could not afford to go through with surgery, using him as their surgeon.

Are you sure you are talking about Boachie? I just went to his website and he even has a plan for people that can't afford to pay? I'm confused???:confused:

Back-out
05-03-2010, 03:47 PM
Jess, Dr Lenke used to take all comers (as long as their condition warranted surgery and they qualified - many criteria). He probably will again, though I suspect it won't until his patient load drops to reasonable time frame.

I think there must be a basic contradiction in a responsible surgeon's mind between wanting to offer the best care s/he* can, and knowing full well that making someone wait while his/her curve is deteriorating, is risky. There IS a strong time constraint involved.

Sorry, about mix-up about which Foundation was being referred to! :o FWIW Boachie is another past president.

*I write s/he here out of habit, though I'm sadly aware there don't appear to be ANY female deformity surgeons. Maybe it requires too much upper body strength...

BTW when I have disagreed with you (insurance, etc) it is entirely based on what I've been told by a given surgeon's staff and sometimes by the surgeon HIM(oh, well) self

jrnyc
05-03-2010, 04:54 PM
Hi Amanda
the issue of "taking assignment" is an important one...because the phrase means that the doctor will indeed take the money the insurance company pays...usually to the patient...so the patient either cashes the check and pays the doctor what the insurance company paid them or the insurance company makes the check out to the doctor...it does NOT mean that they take the insurance money and bill you the rest.....that is NOT taking assignment...that is charging the patient!!

i dont take it personally when anyone on forum disagrees with my opinion...i just consider it their point of view...
and alot of the time, unless you ask the doctor directly (at which point, i've seen some of them blush with embarrassment, cause they often dont want to know the details) you can get a different answer from each staff member in a doctor's office! but things change...i know doctors who have changed which insurance companies they accept from year to year...

jess

Back-out
05-03-2010, 05:16 PM
rohrer:

Are you sure you are talking about Boachie? I just went to his website and he even has a plan for people that can't afford to pay? I'm confused???

I'll check out the website but I can't TELL you both how much I've spoken to both his office rep (who also handles Cunningham) and the HSS insurance rep for both of them who was very adamant, especially about my insurance plan which she referred to as "charity".*

SHE is is the person who told me all this, and generally such persons act as authorized gate-keeper for a given doc. Maybe she is over-stepping her authority, though, and he would be horrified at the things she's saying in his name,

I wonder who I should call to step over her and double check his approach to reimbursement. It's a certainty, though, that he doesn't accept MEDICARE and as for the rest, it's worth checking. I've already been told by several other phone people, that some of the quotes I came up with from the insurance rep were deemed rude and "out of line".

The truth is probably somewhere in the middle.

As for "working with people who have problems paying", my experience is that what that means, is they'll work out a payment plan to stretch over time, usually with an interest rate attached. In fact, there are companies specializing in medical and dental debt, there to take over the arrangements. Then the doctor's office doesn't have to get into the collections business if the pt doesn't come through.

If it's the same plan I suspect it is, it's the one to which HSS itself subscribes for needy (un or under-insured) patients. I've long wondered about it. I picked up their- form to apply. I've gotten the feeling that it's the payment play version of meeting needs. Paying over time wouldn't be an improvement for me, as my finances are due to decline rather than improve (or even stay stable) :( But I will check it out!

To me, meeting needs, is that a significant write off is involved, if the pt meets a means test (and after their insurance kicks in whatever it does).

Mine, for as long as I have had it, has been pretty good with out of state, charges, even though their calculation of U & C (usual and customary) is always somewhat under the real figure for a given zip code. To digress here (and complain), it is maddening to have the final figure come as a surprise! However, no one seems able to give me an accurate figure in advance, for these out of state charges. It's one thing for a pack of gum, or even a single consult, but quite another for such a HUGE ticket item!

Perhaps, I'd be well advised to hire an insurance advocate to arrange things for me paid, on an hourly basis rather than a percentage. Usually they come in to play after the bills are issued, but I want someone to get me a straight answer beforehand. OTOH I don't HAVE to work with Boachie! However, I do think he should be made aware of how his policies are represented to people. As one of the other reps said, "she makes us all look bad".
***************************************

Back-out
05-03-2010, 05:19 PM
*Nb I don't know where she got this as I saw a knee surgeon there too, and he billed Blue Cross $800+ for his visit including a cortisone injection (listed as "surgery!") . After some write-off, he was reimbursed almost $700 including $100 which I'm to pay. That's OK with me, in line with expectations. Hardly charity! Maybe there's a group plan under Capital BC which is tight-fisted and she got us mixed up, but whatever the case:

a) I am only quoting
b) she was rude no matter what
c) I suspect she was representing physician feedback, somewhat distorted For instance, she made it clear she had had to take complaints if she accepted a patient's coverage, and it proved inadequate. The anesthesiologists had complained (bitterly) at their pay back.

She sounded somewhat confused (in facts - NOT attitude!) OTOH it IS complicated, since going out of state means bills have to go through two Blue Cross plans. They translate my coverage into what the U and C prices are in their zip-code. I'll bet there's some randomness involved.

jrnyc
05-03-2010, 05:46 PM
Amanda
why dont you go to a doctor that takes your insurance...i just call the doctor's office and check...if they dont take mine, i'll either ask for a consult and tell them i'll pay out of pocket, or find another doctor...simple...

i dont expect that all doctors will take my insurance...just as i know for a fact that there are lots of doctors who dont take Medicare...that is just the way it is....not fair, maybe, but reality...

jess

Back-out
05-03-2010, 06:49 PM
Sure, I'd rather choose a doctor who takes my insurance, especially while I have this fairly good plan. I would have liked to see Boachie, though, or at least been sure, I was really ineligible. (From this thread, it's seeming to be uncertain). I certainly don't want to fear later, that something went wrong because I had to compromise on my surgeon!

There is a serious problem in determining benefits, though. As I said, the payout is basically only figured out at processing! That's done according to a complicated series of "translations" . My plan's benefits (one of a subset of other Blue Cross PPO plans) have to be priced in the framework of acceptable charges in THAT facility's Blue Cross plans (the one the surgeon, anesthesologist and hospital work with - hoping they're the same)

Some states have at least a dozen Blue Cross companies (New York City alone has three primary ones), each of which has upwards of a dozen plans - they designed them individually for various companies and markets. Those many plans are further broken down by levels of benefits too - Bronze silver, gold, acrylic (JK! Wanted to see if you were listening). All pay and charge premiums by zip code - a fast and sloppy way of approximating level of usage and cost of care.

Blue Cross - a PPO plan like mine, anyhow - is, in many ways, the best. I can go ANYWHERE and to ANYONE, where Blue Cross is taken.

What is NOT ideal, is it's virtually impossible to know what it will cost you in advance because of all the translations. My plan benefits have to be translated into what the new area's U & C reimbursements are.

And there is always the risk some acceptable MD may send me to a lab or radiology facility which doesn't take my insurance. It already looks like that's happened at least once, and I'm afraid I have a mass of fights in front of me - about the legitimacy of what charges I' m supposed to have incurred!

One "EOB" (Explanation of benefits) envelope I opened yesterday had a key indicating what whatever some doctor was charging me, was for a service not even recognized as medically necessary by my plan for my diagnosis!

I can't imagine how that happened, or what it means. I'll bet some busy surgeon will be forced to write a letter justifying it, though - why it wasn't a routine bone density scan (just a guess at the problem).

There are too many damned things to think of in advance, and I'm afraid once I'm hospitalized it may be even more complicated as various charges are incurred without regard for my coverage...

No one could go grocery shopping without price tags, much less car -shopping and this is equal to about ten+ nice new cars! :( :eek: :confused:

Furthermore, the amounts are so vast, Surely there has to be some way to learn in advance what to expect. Sometimes I suspect they just wing it on the day they get every pile of out of state claims, having no real standard to go by. It's NOT just a matter of choosing a doctor who takes BC!

Back-out
05-03-2010, 06:50 PM
And this is one of thousand, millions, of stories which illustrate all too well why this country should have a single payer system.

All this work calculating, billing and second-guessing - theirs and mine - costs money. Wasted money.

Many specialized industries have spring up to support the work doctors and facilities now have to do to handle needless paperwork. And there is immense complex processing that needed to be done to create the conditions which necessitated their paperwork - that of insurance companies and special claims processing offices in each facility (and further on down the food chain). It could and should have been spent on improving patient care - and without shortchanging doctors!

Au contraire, most dedicated doctors don't want to be entrepreneurs with all incumbent headaches, much less being forced to compromise the quality of their care in order to fill quotas, justify choices or conform to ever-changing rule systems! :mad: :mad: :mad:

jrnyc
05-03-2010, 07:19 PM
if you have Blue Cross...you could probably get in to see Dr Anand in CA...the one i paid cash for...i dont have Blue Cross...not even sure if i can get it...i'll have to check in November...

i wanted to see Dr Boachie really badly, too, when i first researched scoli....there was an article about him and a patient of his who was bent over with a really large curve(People Magazine)...but since then, i've found several really great doctors who operate on large curves...not that mine is so large, but i meant that they are doctors who have other patients with large curves...and they have excellent outcomes! right now i am only interested in minimal invasive....dont know that Dr Boachie is doing that...yet...though i do know that he was at a training with Dr Anand last year...

i think there are things that all patients can complain about when it comes to their insurance...after seeing all those people on TV who dont have any insurance, i am just grateful that i do have it...even though it is an HMO...

jess

Back-out
05-03-2010, 08:51 PM
Yes, I'm grateful that I have insurance but that is much overshadowed by knowing I'll only have MEDICARE come next February - and paid, at that! :(

What's with Dr, Anand? Is he so great? As I understand it, minimally invasive may not yet be suitable for large curves. I watched (yuck) a long video of such an operation, done by someone from the U of Chicago where they have a major program. I remember he stressed, M. I. permitted avoiding sawing through the muscles groups, losing MUCH less blood, and for a much easier recovery. However, he (surgeon) said that at present it was only used for patients with lumbar curves only.

I know often surgeons disregard surgery they don't know how to do, but OTOH I don't want to be someone's guinea pig. One wants to go to someone used to doing the procedure - time and again.

I had my cervical stenosis done minimally invasive (one overnight and then home instead of the standard double fusion - also with titanium rods and cadaver bone, etc,). I begged that world-famous surgeon (no small ego) to work on my scoliosis but he said it couldn't be done yet.

OTOH maybe he personally didn't know how to do it. He was terribly worried about throwing my center of gravity off still more. (And I can only respect his caution!). But maybe it CAN indeed be done! What's with this Dr. Anand?

I really like the idea of sparing the spinal muscles - after all, they support the whole shebang. But can it be done - well? Dr. Neuwirth certainly gave me a resounding "no". But that doesn't mean anything for sure, other than that he can't do it and therefore doesn't believe it's safe. Undoubtedly, it's NOT - by him!

It's a tough call, Jess. Minimally invasive knee joint replacement (something else I need) seemed like the wave of the future, but it turns out to have special risks which have not yet been accounted for. Some patients need to be re-operated because they end up off balance somehow.

I'm confused, I don't mind admitting. People DO tend to make a virtue out of necessity and right now, most are necessarily doing regular fusions. But are they ready for a really competent, minimally invasive approach? I feel I need to read the medical lit to find out what the risks are compared to "ordinary" long fusions. How else can I learn what the risks are, and why everyone isn't doing it that way? Have you done any such research?

Thanks!

jrnyc
05-03-2010, 11:51 PM
minimal invasive surgery has been done for a long time for thoracic curves...now it is done for lumbar as well...i specifically FLEW OUT to CA to meet Dr Anand, knowing that he doesnt take my insurance, just so i could stop hearing people, doctors especially, tell me that it wouldnt work for larger curves...that is completely wrong...and Dr Lonner will do minimal invasive for me...a year ago, he wasnt offering to....

minimal invasive spares the muscles as much as possible from the ripping and cutting of what i call "fillet of fish" surgery (i heard that somewhere...i cant claim inventing that phrase, but i like it)...it is cutting of the muscles that is one of the things that contributes to the difficulty of recovery....since they can reach the areas they need to reach without that kind of cutting, i am all for it...as a matter of fact, i started delaying surgery as soon as i first heard about it...determined to find a doctor who would do minimal for me! wa..la...or oi la...(splg)....or aha...:)

jess

Back-out
05-04-2010, 12:37 AM
What did Dr. Anand tell you and what did you think of him? What kind of fusion was he proposing to do (from - to)?

Thanks!

jrnyc
05-04-2010, 01:00 AM
i will write a P.M. to you, Amanda...

jess

golfnut
05-05-2010, 03:11 PM
In defense of Dr. Lenke, the St. Louis Post Dispatch (4-11-10) had an article about Children's Hospital and surgeries that are performed on charity cases. Quoting from the paper: "Dr. Lenke performs surgery for no pay on an international child about every two to three months." 'That's why I became a doctor', he said. "His waiting list, which can reach up to 12 months, includes seven children without ability to pay."
I know that whatever consumes Dr. Lenke's time whether it's teaching other surgeons or his involvement with the Foundation, that his hear is in the right place. I am thankful to have such a wonderful, caring, dedicated surgeon.

golfnut
05-05-2010, 03:15 PM
Jess and Janet,
I was posting a reply to an earlier page of criticism of Dr. Lenke and just
realized that Janet had already mentioned the same article on a later page. I failed to notice the other pages of posts on the same topic. Sorry to be repetitous.

jrnyc
05-05-2010, 03:50 PM
Hi Karen
when i first read about Dr Lenke limiting his patient load to "severe curves," it said (incorrectly) that it was to head the National Scoliosis Foundation...i thought that was ridiculous, since the person now heading it has no M.D., and it seems to not be needed, since there is a medical advisory board...it was later corrected that Dr Lenke is to head the SRS...that made more sense, that his time would be taken up....

i was saying that plenty of doctors operate on international...and very poor...patients...with very severe curves..but dont drop their lower curve patients (Dr Boachie, Dr Lonner, and others i am not familiar with)...i wouldnt want to have to wait for my lumbar to reach 90...it is at 61 now...to get a doctor who would consider me "severe enough" to operate on...i dont care for the whole exclusivity thing...that any doctor is so brilliant that the rest of us poor ordinary folks dont qualify...obviously, any doctor can limit their practice to any exclusive group of people they desire, but i dont have to be impressed with them! i understand that all doctors have limited time...and if they have to pick and choose who will be their patients, then that is their right to do so...but i dont have to be impressed with their "brilliance"
i also said i wouldnt want a doctor to tell me that my tumor wasnt big enough for him to operate on! and i added that this is just my opinion..

jess

Doodles
05-05-2010, 11:02 PM
No problem, Karen. I think we were having parallel thoughts. Thanks. Janet