Medical Costs - Dr. Boachie

[Lori]

On-going recovery

Hi All,
Thanks so much for all the feedback on the pain medication. Sorry it took me so long to respond but I've just been wiped out. My daughter is making steady progress but continues to complain of pain...but less and less each day. We did decrease the medication a little and that seems to be holding her. She's been out for some walks in the neighborhood and is beginning to do more and more for herself. She can now get out of bed without my assistance. She is still walking bent to one side but I think that is because of the anterior surgery and the pain from the incision. Her hips are even and her back is straight. I think she gained about one inch in height. She's still sleeping in the hospital bed but we still have it for another week or so. When she asked me yesterday about going shopping for new clothes I knew she was on her way to recovery!! I actually went back to work today...went home at lunchtime to check on her. She has a friend visiting and all is well. We have a post-op office visit scheduled for 8/18 and I'm hoping all will be well. My biggest concern at this point is that there should not be any long-term residual pain...but I guess that is everyone's concern. There is really no reason to think she will...I'm just praying for a full recovery. Hope you all are doing well. Thanks again for all the support. Lori

[nicoles mom]

Hi Lori
Glad To Hear Your Daughter Is Doing So Well.
Theresa

[luv4beth]

Hi Everyone,

I know many of us who are going somewhere other than Shriners for surgery worry a great deal about money, and there are some who might stay away from a particular doctor or hospital because they are scared of the out-of-pocket expense.

I just wanted to share a piece of good news. My daughter went to doctor Boachie-Adjei at the Hospital for Special Surgery. We have CIGNA PPO. The doctor is out of network, and our coverage is 60/40 with a $3,000 out of pocket limit (NOT including co-pays for office visits, etc.).

All the pre-op testing, the MRI's, the second opinions, the x-rays, and the hospital bills totalled about $125K. We paid about $5,000 out of pocket. Dr. Boachie's bill was $37,700. The insurance company paid about $27,200, and Dr. Boachie WROTE OFF THE REST! He is an angel disguised as a man, I swear! It's a lot of money, but we won't have to mortgage the house to pay the bills, yeah!!!

Anyhow, just wanted to give folks a realistic idea of what those bills will look like. It should be noted that the hospital will also work with you to set up a payment plan for the balance owed to them, and they offer financial aid to those in need.

P.S. My daughter is doing extremely well, back to school, straight back, and virtually no pain.

Hello, I am not having the same experience with Dr. Boachies office. We met with him in Jan,07. and after seeing 5 other surgeons, we felt very strongly he was the best. We were so relieved to have found him, as our daughter has a very complex case. We are sceduled for April 4 however we were told by his office that we may have to cancel. We have BCBS, it is traditional so we are allowed to go out of network/participator, the insurance co said they would pay 70% and 50% which is what our plan reads. The person at Dr. Boachies office said we have to have that in writing along with the $ amount not just the %, our ins co said they dont do that. If we cant get it in writing, we have to come up with half of the cost of the surgery up front If we dont, her date will be cancelled. I don't know what to do. She is in traction right now in the hospital preparing for the surgery. Her curve was 100 and 94. I know he is the right Dr. for her. I have to find a way to work this out. I told his office we would sell our home, his office said "everyone says that". Truth be told, I would. Our daughters health is worth everything to us! We only want the very best for her. Does anyone have any advice for us about insurance?
Lisa

[mariaf]

Hi Lisa,

I don't know if things have changed, but back in 2000, I had called Boachie's office considering an appt. for my son (we ended up with another ortho because my son was very young and we wanted someone who treated lots of children, particularly younger ones).

Anyway, I remember being told on the phone, at that time, that he did not participate in any insurance plans and then I was given the (very high) dollar amount for an initial consultation. I am sure the woman I spoke to meant that he was not considered "in network' on any insurance plan, rather than that he did not accept insurance - but the whole tone of the conversation was as if she was trying to discourage me from making an appt. unless I was willing to dig deep.

(Of course, I too, would have sold my home if I needed to for my son.)

I've never shared any of this because it was a long time ago - and I've heard wonderful things about the man, but I remember the call like it was yesterday - and when I read your post, Lisa, I didn't think it was right not to share it with you.

I really feel for you, being in the position you are in. All my best wishes that everthing works out for you. And please keep us posted.

hugs,

[luv4beth]

Thank you Maria F.
Thank you for sharing your experience. I have heard wonderful things about Dr. Boachie. I have heard he is not just a great surgeon but a wonderful man also. He is the only surgeon I feel can handle our case. We have seen at least 5 surgeons in the past 6 months and after we met him our whole family felt we had found the only man we would trust our daughter to. Our daughters case is very complex, she is 12 and weighs 42 pounds. She also has muscle weakness and low pulmonary function. Her curves are 100 and 94. She is still in traction but can not remain in traction forever! Our ins. BCBS policy says they cover 70 % for non-participators. But they wont give it to his office in writing? If I cant get it in writing they will cancel her appointment. We have our flight arragements, and the pulmonologist at cornell has been notified we are coming....
Thank you for listening~!
Lisa F.

[Janet]

Dr. Boachie - fees

I have a consultation with Dr. Boachi in mid-April. I have a California Blue Cross PPO with max deductible of $3,500 per year.

Theresa, who handles insurance at Dr. B's office, said that they had not had any experience specifically with the plan I am in (and they DO differ greatly, depending on what your employer chooses, even within the same state). Since Dr. Boachie does not contract with any medical insurance plans, except Medicare, he would be compensated by my ins. co. as an "out-of-network provider." The problem Theresa mentioned is that the ins. co's DO give pre-authorization, but not the amount approved, so one goes in blind. She said Dr. B. "expects to receive 80% ot total fees" (combined insurance contribution & own money) eventually. If there is no known amount from ins. co. pre-op, you must pay $10,000 down, and pay off the rest to reach the 80% mark.

Re-reading these posts, seems that his patients are hearing / experiencing different, & sometimes conflicting, info.

[mariaf]

Hi Lisa,

Happy to share my experience with you, although I don't imagine it can help the current situation - just wanted to offer my support

Just out of curiosity, I see that you are in PA, did you happen to see Dr. Betz in Philadelphia? He's probably one of the only other orthos in the country, besides Boachie, that I have heard of who handles cases of this complexity.

I truly hope everything works out for you and that it never comes to them cancelling your daughter's surgery (which would be heartless). I know most doctors expect to be paid - I guess I am just so accustomed to dealing with Shriners that it was odd for me to hear it.

Best of luck, and

hugs,

Maria

[luv4beth]

Thank you for your kind thoughts. Yes, we have gone to Dr. Betz, he was not as confident about our daughters case as Dr. Boachie was. I really think it is because Dr. Boachie does have the most experience with very complex cases such as our daughters. I also agree that Dr. Betz has a wonderful reputation. I just can not give up and say, well because we don't have 20,000 to put down we have to go somewhere else. I know that would not be the best for our daughter, how could I live with making a decision that I know is not the best for her.... all because of money? We obtained the best plan with BCBS, we did not go with an hmo or ppo for the very reason of having to go out of state sometimes for our daughters care. We needed the freedom to be able to do that. I will find out more tomorow from the insurance co if they are going to provide the documents his office needs to keep her appointment. My husband is afraid they have already cancelled it. Meanwhile we are in SLC Utah, our daughter is in preop traction, our flight args. are made. We live in PA. We have been here for almost 6 weeks now. My husband took a temp leave from work and has found a job here to fill in. Our daughters is breathing better because the curve is lengthening... in traction she is 65 and 72. She started at 100 and 94. The origianl plan was traction and then the veptr hybrid at primary childrens with Dr. Smith. He is a participator and the Shrine is doing the traction. After a few weeks of evaluations we were advised that the veptr would not be the best for our daughter. The risk is too high for her, repeated surgeries for expansions. That is when we decided we needed to go to Dr. Boachie for fusion, as we saw him in Jan, 07 before we came out to SLC, we wanted to have the best plan in place just in case the veptr was not going to work out, as we were told it may not. So that is where we are..........can anyone give us any advice on how to work this out with our insurance? We are allowed to go out of network........we just need them to give Dr Boacies office a letter to confirm they will pay and what amount.
Thank you,
Lisa
email. Danpoolscape@aol.com

[Janet]

Insurance advice???

Luv4Beth-

I have no idea whether this would help, or help timely, in your case: here in CA, there is a state Insurance Commissioner, whose job it is to make sure the insurance companies do what they are supposed to do. Perhaps if your state has such a regulatory office, or maybe a patients' rights advocacy group of some sort, you can use them to "convince" your ins. co. to put it in writing (a variation on the squeaky wheel approach).

I am so sorry to hear that you are being treated this way, and I cannot imagine someone of Dr. Boachie's reputation refusing to do the surgery because of insurance-company bureaucracy. Is it possible for you to speak directly with Dr. B. to discuss the finances?

My thoughts are with you. Good luck and, if you have the time, keep us posted on what transpires.

Janet

[mariaf]

I also agree that Dr. Betz has a wonderful reputation. I just can not give up and say, well because we don't have 20,000 to put down we have to go somewhere else. I know that would not be the best for our daughter, how could I live with making a decision that I know is not the best for her.... all because of money?

Hi Lisa,

I hope you did not misunderstand me - I was not suggesting that because of money concerns you should do anything other than what is in your daughter's best interests. Your attitude is EXACTLY what a parent's attitude should be - that you can't put a price on your child's health

We have good insurance and live in NY with access to all the so-called best doctors but we went to Shriners in Philadalphia because in our son's particular case, Dr. Betz and his team offered us the best option and we have been extremely happy with the care he received there. It seems that in your daughter's particular case, Dr. Boachie is the one you feel most comfortable with - and I truly hope and pray you get this thing with your insurance company ironed out so you can stick with your plan.

Please keep us posted - your family will be in my thoughts and prayers.

[MATJESNIC]

Dr. Boachie is amazing the way he helps children in other countries. I just hope he doesn't turn away children in his own backyard who also need special surgeries.

[luv4beth]

I hope you did not misunderstand me - I was not suggesting that because of money concerns you should do anything other than what is in your daughter's best interests. Your attitude is EXACTLY what a parent's attitude should be - that you can't put a price on your child's health

Hello,
No I did not misunderstand you at all. I realize what you were suggesting and I didn't take it wrong, thank you for clarifing it though We just had some more news......My husband just got off the phone with the office mangager in Dr. Boachies office. She stated that we need to have 80% of the total cost of his charges paid up front in order to keep our surgery appointment. My husband spent all day again on the phone with BCBS and they have authorized our daughter to have her surgery with him, they also stated the dollar amount his office quoted are within their reasonalble charges so they will pay a minumum of 70 % and max of 100% depending on the final bill. At worst it will be 70% of his charges. My husband called his office (DR. Boachies) and spoke with his billing staff, which told my husband that what he was telling her meant nothing...it is not in writing and she has only seen a patient get the amount in writing 2 time in 9 years. So I guess what they are asking us to get is next to impossible. My mother and father were both present at BCBS during this conversation as witnesses. Also our ins. Broker was given the information directly from BCBS. Unfortunalty since The Dr. is not a particapator of any insurance company the ins. co. will not give them anything in writing. They stated they just dont do that with non participators and that no ins companys will do that.My husband then called Dr. Boachies office again and at the end of the conversation said they would take 50% of his total charrges up front as a downpayment. If we can not provide that she will not be having surgery with him. I don't undserstand this at all, we know he does not participate with any ins. but our ins allows us to go with non particapators, its not a ppo or hmo. The percentage they quoted us is in our provider manual. Also since our daughter is disabled, vaccine associalted polio, she has a ssid (medical card) for a secondary coverage. We as a family have the BCBS, we have had very good exp. with our insurance covering Bethany. My question is, how does anyone secure an appointment with him if insurance companys wont give his office in writing what they need. If anyone here is listening please help. What should I do? Beth is in pro-op traction and to look for another surgeon with his crudentials is not going to happen in the next 2 weeks. We have been in the hospital since january 28. How has anyone here gotten to have surgery with him....did you have to put up 50% down? Did your insurance company give him a letter of what they would pay? If you can give me any advice please do. His office told my husband that he (meaning my husband) is "jerking them around" because he keeps calling them with verbal information $$ from the ins. co and not a written one.....even though they said getting a written commitment from an ins com has only happened 2 in 9 years? I was taken back at the comments of "jerking around". We are trying so hard to get the letter they need. I guess the odds of getting the letter are so slim, so what do most people do?
Beth is in
Please send your advice..... our email is danpoolscape@aol.com
Very sincerely,
The Flanders 570-332-5138

[mariaf]

Lisa,

I am so very sorry that you and your family are being treated in this awful manner. As you say, with your daughter in traction, it will be impossible to find another qualified surgeon and secure a surgical date within the next two weeks. What they are doing to you is unconscienable - and I hope and pray for a miracle for you and your daughter.

Please keep us posted.

hugs,

[luv4beth]

Thank you so much. Bethany prays everyday for a miracle. We as a family also pray together for Bethany each night. Bethany has alot of faith and she is not giving up.
We are still trying to work this out.
The Flanders

[lelc2002@yahoo]

did you talk to the doctor about this? just curious....I know normally we don't discuss this kind of stuff with our doctor but..maybe?....Ly