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  • Has anyone had to pay in advance?

    Since early last June I've happily been on Dr. Boachie's surgery schedule for January. The "predetermination letter" was sent to my insurance company (Blue Cross of Georgia - PPO) a few weeks ago, and I was told by Theresa, the billing lady for Dr. B, that it was my responsibility to find out from BC what they would pay. I've since talked to countless people at both BC of GA and Empire (BC of NY), but they all say they cannot give me that information.

    This week I had a call from Theresa, who informed me that since I couldn't get an answer from BC, I would need to pay 50% of the surgical fee of $108,000 now! I am just reeling from this! I was told back in June that a prepayment would be required, but the figure mentioned at that time was considerably less than $54,000 and one that I could have managed. I know several people who've had surgery with Dr. B, but none of them paid anything in advance. I asked her why I was being singled out. She said I wasn't, but that since I have an individual policy, it will pay less than a group policy.

    My husband and I are not wealthy people, and we don't happen to have $54,000 in cash. So now, after waiting 6 months and after counting on surgery with this doctor, it looks like I'll have to start all over again in a search to find a surgeon who can help me. Needless to say, I was devastated. I felt like the rug had just been pulled out from under me. I didn't post until today because my eyes were so swollen from crying, I could barely see the computer screen. But, today I feel better...and a bit stronger...and I will just do whatever I have to do, and if that means starting over, I will. Actually, I don't fault Dr. Boachie for this; he's certainly free to charge whatever he wants. Perhaps the majority of his patients are able to pay these amounts.

    I would like to ask any of Dr. Boachie's patients if you had to pay part of your fee up-front, and if so, what percentage? In fact, has a patient of ANY other doctor had to pay in advance? I would appreciate any feedback that could help me understand this.

    Peachy

  • #2
    My dd is not a patient of Dr. Boachie, but I wanted to let you know that you will be in my thoughts and prayers. My eyes teared up when I read of your situation.

    Is it possible that your insurance can contact the doctor's office directly with what they will cover? I know we were given the runaround with our insurance just trying to pay for getting 2nd opinions from out of network surgeons. One of the doctor's offices did write a letter, but I think it was dd's general dr. who intervened for us and got the insurance co. to accept our insurance co-pay.

    Also, is there a top surgeon in your network that you could work with? I know in our case, our original insurance was not going to pay for the consults we had with 2 surgeons b/c they were "out of network." Fortunately, dh's insurance will be changing as of Jan. 1, so we will be able to have one of those surgeons follow our dd's case.

    Please keep us posted!

    Take care,
    Marian

    Comment


    • #3
      Peachy,

      I am so sorry you are going through this. This is not the first time someone has posted about Boachie's office (this "Theresa" in particular) treating patients in this way. I would be upset too, being asked to come up with $54,000!!!

      It must be especially hard having to deal with this during a time that is already stressful.

      Funny, I know that Dr. Boachie, quite generously, gives his services at no charge to patients in his native country....yet such a different policy here in the U.S.

      Best of luck to you - I hope you can work something out with Boachie's office....or alternatively, that you can find another surgeon that your are comfortable and who will work with your insurance company (there are plenty of doctors who WILL do that)!
      Last edited by mariaf; 12-06-2008, 09:07 PM.
      mariaf305@yahoo.com
      Mom to David, age 17, braced June 2000 to March 2004
      Vertebral Body Stapling 3/10/04 for 40 degree curve (currently mid 20's)

      https://www.facebook.com/groups/ScoliosisTethering/

      http://pediatricspinefoundation.org/

      Comment


      • #4
        Peachy, this is my #1 issue with Boachie's office ... "The Wrath of Theresa". It's ridiculous.

        Are you a first timer or revision?

        There are other options for both.
        Fusion is NOT the end of the world.
        AIDS Walk Houston 2008 5K @ 33 days post op!


        41, dx'd JIS & Boston braced @ 10
        Pre-op ±53°, Post-op < 20°
        Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


        VIEW MY X-RAYS
        EMAIL ME

        Comment


        • #5
          When I said I didn't fault Dr. Boachie for this, I didn't mean in any way to imply that I blame Theresa. I truly do not! I believe she's only doing her job, and that has to be very hard for her at times - especially when she asks for a sun of money that may be out of reach for some of us, and then the patient begins to blubber on the phone, as I did .

          Marian, what a sweet note! Now don't you be tearing up; I've done enough of that for both of us! No, Blue Cross won't tell Theresa what they'll pay either, only that I'm covered. I saw two in-network docs, but had no confidence in either.

          Maria, thanks for the good thoughts!

          Pam, I'm a first-timer for surgery T-2 to S-1.

          I think I was so upset because I'd been counting on Dr. B and the January date for so long. Also, being a paranoid person, it just seemed to me that I was being treated differently from other patients.

          Thanks, guys, for your notes. I'm still wondering if there's anyone who has paid in advance.

          Peachy

          Comment


          • #6
            I've been thinking of you too, Peachy, and how disappointing (to the nth degree) this whole thing must be to you. You have probably already tried explaining to BC that Boachie's office will require you to pay in advance if you aren't able to find out how much they will pay for your surgery. It just seems like there needs to be a patient's advocate somehow... but not sure if that's a possibility. Best wishes with making some progress-- either with the insurance/Boachie situation or in finding someone else you will have confidence with. BTW, BC did pretty well for me, and we sure didn't have to pay anything in advance.
            71 and plugging along... but having some problems
            2007 52° w/ severe lumbar stenosis & L2L3 lateral listhesis (side shift)
            5/4/07 posterior fusion T2-L4 w/ laminectomies and osteotomies @L2L3, L3L4
            Dr. Kim Hammerberg, Rush Univ. Medical Center in Chicago

            Corrected to 15°
            CMT (type 2) DX in 2014, progressing
            10/2018 x-rays - spondylolisthesis at L4/L5 - Dr. DeWald is monitoring

            Click to view my pics: pics of scoli x-rays digital x-rays, and pics of me

            Comment


            • #7
              Hi Anne,

              Unfortunately, for out-of-network coverage, I think that it is probably on an individual case basis, and depends on the insurance plan. Mine happened to be a very good plan. I hope and pray for you that you can get this all figured out and have your surgery in January as you planned and counted on.

              Keep us posted, ok?
              __________________________________________
              Debbe - 50 yrs old

              Milwalkee Brace 1976 - 79
              Told by Dr. my curve would never progress

              Surgery 10/15/08 in NYC by Dr. Michael Neuwirth
              Pre-Surgury Thorasic: 66 degrees
              Pre-Surgery Lumbar: 66 degrees

              Post-Surgery Thorasic: 34 degrees
              Post-Surgery Lumbar: 22 degrees

              Comment


              • #8
                This is exactly why I am not able to have Dr. Boachie do my surgery and why I am going to see Dr. Rand in Boston next Monday. I met with Boachie at the beginning of October and was told that I would not be able to schedule surgery unless or until i could get my insurance Personal Choice (Blue Cross) to tell us exactly what they would be willing to pay. Unfortunately, I haven't received my letter from Dr. Boachie's office with the necessary codes to turn over to my insurance company for an exact code by code amount of what they would pay. I spent about 4 hours in the office between xrays and the examination and waiting, to be told by Theresa that unless I could either pay up front for the surgery or get my insurance company to commit for a certain amount of money, then I may as well get another doctor. They in fact gave me the name of Dr. Donaldson in Pittsburgh as another doctor. I had never heard of him either personally or on this listserv, and 5 minutes of research told me that Dr. Donaldson did his internship with Dr. Boachie. I couldn't find much else about him and he wasn't included as a provider for my insurance although Dr. Rand in Boston is. I apologize for such a long post but this is the first time i have seen in print what I knew I was dealing with. After my visit with Boachie, I posted about this and asked if anyone had to pay up front before surgery was performed. You are the first person who had a specific $ amount. I am very sorry this happened to you and I too would be devastated. I am angry about the whole process and I am reeling because it is all about money. If I had any extra money I could perhaps bargain my way into surgery but I don't. At the time of the visit they had no problem taking my $450 for the visit but it is obvious they have been burned by patients who have had surgery and could not or would not pay anything so that now unless as a patient you provide proof to them of what you will pay, you are sh** out of luck.
                best wishes to you peachie.
                avis
                1987 Lumbar Laminectomy (forget which levels)
                2005 A/P fusion, L2 - L5, 2/2005
                2009 2 Posterior fusions, T6 - Pelvis, 2/10 & 2/18,
                Dr. Frank Rand, NEBH

                Comment


                • #9
                  Peachy- Maybe Cathie(Bsprings) will come on the forum as she had some scares with her insurance. I thought she might of had Blue Cross.
                  Why is your insurance co. saying they will not give you an answer? what is their reason, increasing costs or something else???
                  By the way, I have met Theresa several times on my visits to Dr. Boachie's office and she is a FINE individual!!!!! Why blame her when it seems to me it is the insurance companies causing the problems here.
                  I would demand an answer from my insurance company..
                  This brings to mind the movie "Sicko" by Michael Moore, I could go on & on &on on insurance co.s.....Ly
                  Last edited by lelc2002@yahoo; 12-10-2008, 07:18 PM.

                  Comment


                  • #10
                    It seems to me that the Doctor's office should be contacting the insurance company instead of the patient. After all, the patient could say that the insurance will pay whatever he or she thinks the Doctor wants. I also believe that there are many other superb Doctors out there that do excellent scoliosis surgeries so I don't understand why so many people on this forum think that Dr. Boachie is the only surgeon to go to. Is he God? I personally think that he is greedy, not accepting people that can't afford to pay so much money out of pocket. How much money does any one Doctor have to make! That is my opinion and I'm sticking to it.
                    Sally
                    Diagnosed with severe lumbar scoliosis at age 65.
                    Posterior Fusion L2-S1 on 12/4/2007. age 67
                    Anterior Fusion L3-L4,L4-L5,L5-S1 on 12/19/2007
                    Additional bone removed to decompress right side of L3-L4 & L4-L5 on 4/19/2010
                    New England Baptist Hospital, Boston, MA
                    Dr. Frank F. Rands735.photobucket.com/albums/ww360/butterflyfive/

                    "In God We Trust" Happy moments, praise God. Difficult moments, seek God. Quiet moments, worship God. Painful moments, trust God. Every moment, thank God.

                    Comment


                    • #11
                      Ly,

                      I agree with you 100% about Theresa. Please see Post #5 above. I said I absolutely do NOT blame her for my problem.

                      Peachy

                      Comment


                      • #12
                        Originally posted by lelc2002@yahoo View Post
                        Peachy- Maybe Cathie(Bsprings) will come on the forum as she had some scares with her insurance. I thought she might of had Blue Cross.
                        Why is your insurance co. saying they will not give you an answer? what is their reason, increasing costs or something else???
                        By the way, I have met Theresa several times on my visits to Dr. Boachie's office and she is a FINE individual!!!!! Why blame her when it seems to me it is the insurance companies causing the problems here.
                        I would demand an answer from my insurance company..
                        This brings to mind the movie "Sicko" by Michael Moore, I could go on & on &on on insurance co.s.....Ly
                        Hi Lynne,

                        Just to clarify, not necessarily in this case (but in several other cases I have read about here), I think the problem was not so much that the insurance company wasn't giving an answer, but that they were giving one in "percentages". From my experience with several different insurers we have had over the years, that's quite typical, to say they will cover 80% of a procedure, for example. I have heard, as I said, of several cases where Boachie's rep wanted a firm dollar amount, rather than a percentage - perhaps because sometimes insurers have "caps" to the dollar amounts they will pay, I don't know.

                        Hopefully, Peachy can get her insurer to quote a percentage (I can't believe they won't even give a percent of what the plan covers - it has to be listed in the policy somewhere); and hopefully Boachie's office will accept that.

                        Again, I could be wrong, but I think Boachie has a dollar figure in mind that he wants (here it's $54,000) which is "guaranteed". Also, (and I am not bashing his office or anything like that) but I do find it strange that this issue keeps coming up over and over again only with this office. I have not read or heard of this same issue coming up, at least not with any frequency, with other doctors. So, logic tells me that the issue could be not with the various insurers, but rather with his practices (of course, he's free to run his office any way he chooses and to charge whatever fee he wants).

                        (I also agree with the person who said that the doctor's office should contact the insurance company to discuss what will or will not be covered, not the patient.)

                        I just hope one way or the other, the issue is resolved so others don't have this added stress in the future.

                        Best regards,
                        Last edited by mariaf; 12-11-2008, 06:08 AM.
                        mariaf305@yahoo.com
                        Mom to David, age 17, braced June 2000 to March 2004
                        Vertebral Body Stapling 3/10/04 for 40 degree curve (currently mid 20's)

                        https://www.facebook.com/groups/ScoliosisTethering/

                        http://pediatricspinefoundation.org/

                        Comment


                        • #13
                          Here's my take on the whole Boachie/insurance situation:

                          1. You avoid ALL of the hassle if you live in New York and/or have New York-based insurance (as I do).

                          2. He funnels a lot of money back into his FOCOS foundation, and makes no secret of the fact that he is committed to raising as many funds as possible for it.

                          3. He is in great demand and therefore does not have to hassle with the insurance companies. That's his perogative.

                          4. I agree with Sally that he is not God, and while he is certainly excellent, there are other great surgeons out there who subscribe to insurance plans. I hesitate to call him greedy, though --- certainly he's not more greedy than any of the other surgeons out there who are raking in the bucks. I believe that to a great extent, scoliosis surgeons earn their salary; it's a gruelling surgery that demands huge amounts of skill and physical stamina.
                          Chris
                          A/P fusion on June 19, 2007 at age 52; T10-L5
                          Pre-op thoracolumbar curve: 70 degrees
                          Post-op curve: 12 degrees
                          Dr. Boachie-adjei, HSS, New York

                          Comment


                          • #14
                            Originally posted by Singer View Post
                            2. He funnels a lot of money back into his FOCOS foundation, and makes no secret of the fact that he is committed to raising as many funds as possible for it.
                            Yes, I (and proably a lot of others) are aware that while Boachie charges a lot of money to his patients WITHIN the U.S. and does NOT accept insurance from them, he offers his services AT NO CHARGE to patients in his native country.

                            Of course, he has every right to do that - it is, as you say, his perogative. Nobody could argue that.

                            Having said that, I think that double standard doesn't sit well with a lot of folks here in this country, where he makes his living.
                            mariaf305@yahoo.com
                            Mom to David, age 17, braced June 2000 to March 2004
                            Vertebral Body Stapling 3/10/04 for 40 degree curve (currently mid 20's)

                            https://www.facebook.com/groups/ScoliosisTethering/

                            http://pediatricspinefoundation.org/

                            Comment


                            • #15
                              I totally understand this. But let's remember that most people in Ghana are at a severe financial disadvantage compared to the rest of us, and many of the kids he operates on suffer from curves resulting from tuberculosis and other diseases that are more treatable in the U.S.

                              I would actually love to hear what Dr. B himself has to say on this subject but unfortunately I don't have the guts to ask him, heh-heh.

                              Speaking strictly of his expertise now, I think his reputation as a world-class surgeon is deserved. But the almost-mythical status he has generated on this Forum is distorted.

                              All is not lost if someone is not able to avail themselves of Boachie's services.
                              Chris
                              A/P fusion on June 19, 2007 at age 52; T10-L5
                              Pre-op thoracolumbar curve: 70 degrees
                              Post-op curve: 12 degrees
                              Dr. Boachie-adjei, HSS, New York

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