visit with doctor

[theizzard]

Hi everyone, Met with Dr. Boachie yesterday and it was without doubt the most comprehensive and thorough consultation. i was ready to sign up for a surgery date but they had me meet with theresa (his financial person) first. she explained to me that i had to take the codes that would corrollate to my surgery, and i would have to get blue cross to tell me what they would pay for all the codes that would be used in my surgery. she said they do this now because they have been burnt many times by people who have no money to pay anything. so as thrilled as i was to have met him and felt supremely confident in his abilities, according to theresa, trying to get b/c to provide me with answers and then being able to pay the difference after b/c paid, left me as depressed and as disappointed as i could be. so i have to wait for theresa to send me a letter with the codes and then i have to begin my assault on blue cross. right now he is booking surgeries for february. if i am able to get answers from blue cross, god knows when that will be. to make up for what he knew was major disappointment, he gave me the name of a doctor he recommends in pittsburgh with the idea being b/c will pay more if the surgeon is in state. sorry this is so long. i couldn't do this last night when i got home. i was too beat and miserable from my long day in ny.
avis

[Janet]

Avis,

I am so glad you saw Dr. Boachie. He is the best!

I had Blue Cross of California at the time of my surgery. Theresa provided codes but BC never committed beforehand as to what they might pay, so I went into surgery with no idea of the likely reimbursement. BC lost half of the claim submitted by Theresa, so for the first part of the claim they paid about 70% of what was billed. After Theresa resubmitted the claim, they paid less than 6% of the remainder of the bill; I have filed a grievance and have provided them with documentation provided by Theresa for other out-of-state BC patients whose procedure codes were similar to mine; in 3 cases, BC paid 100% of all charges (one patient initially was granted a very small percent, but after appealing, received 100%), and in the remaining case BC paid about 88%. I am still waiting for BC grievance department to return my calls.

I don't think you'll get much help from BC, but Theresa will help you muddle thru - just plan on having to spend some of your post-op recovery time on the phone dealing with your BC representatives.

It may be worth your time to see the Pittsburg specialist that Dr. B mentioned, and find out what the financial situation would be if you chose that doctor (as well as whether you felt very good about the doctor). That way you will have better information to help you in your decision. Do you know if this doctor is in-network? If he is out-of-network, I wonder whether being in state makes a difference as to how much BC will pay, as per the results of the above-mentioned out-of-state cases.

Of course, everyone's situation is different. For me, after seeing several local surgeons who were contracted with Blue Cross, and then consulting with Dr. B., the choice was easy, even though I didn't know (and still don't know) how much BC will pay in total. I just wanted the best surgeon to work on my back.

I am thinking positive thoughts for you that this will all work itself out to your satisfaction.

[debbei]

Avis,

I'm sorry that you had that disappointment, I can totally understand. $$ is a big part of this decision. I can't remember exactly where you are--is it near Philladelphia? Good luck with your decision. See what Teresa comes back with, maybe you'll both be surprised.

[theizzard]

i have seen 2 in philly who are in network and are definitely good and competent doctors. the problem is dr. boachie's reputation, which is beyond reproach. if there was just one person who did not think he was the best surgeon then i could go with a philly doc but there isn't! my back is screwed up and as I go through this process, I realize that my 3 level fusion 3 years ago, probably should have been the full spine work that dr. boachie and the other doctors have recommended. based on that, i would prefer to stick with him (if I can) or someone that he personally recommended. Also, he made it clear that in the operating room, he has a doctor working with him although he is there to oversee and do the majority of the work. he wanted me to know that he will not be the only one in there working on my back. i don't believe theresa will let me sign on for the surgery unless i demonstrate to her that i will pay what the insurance doesn't. we need to set up fundraisers for those of us who can't fork over $90k for the procedure.
thanks for listening.
avis

[Singer]

By a happy conincidence, my husband works for a NY-based company so we had NY-based Blue Cross. This eliminated a lot of insurance headaches for me. Insurance paid for about 80 percent of my bill and Dr. B wrote off the rest after I asked Theresa if I HAD to pay the difference. We still ended up paying a few thousand out of pocket but I was expecting that.

I realize the whole insurance process is very difficult for Boachie's out of state patients. I believe there are other docs in the NYC area with equally good reputations who are easier to work with financially. And I would definitely check out the Pittsburgh surgeon; I would trust the reputation and expertise of anyone Boachie recommended.