Friday, February 22, 2008

Usual & Customary

I have a headache like you wouldn't believe. I spent the better part of 2 hours today on the phone with my insurance company, trying to find out if I could get the foremost expert on gastric bypass surgery in New Jersey to perform mine.

Short answer? Only if I'm rich enough not to need insurance. The doctor in question doesn't take insurance (except Medicare). My insurance company, to go out of network, I would have to cough up a) $750.00 deductible PLUS 20% PLUS whatever the bill ran above the "Usual and Customary" fees for the area I live in.

The top surgeon charges $12,500.00 for a Rouen en Y bypass (that's the biggie, the lap-band is only $7,500.), so you can see that it would wind up costing me a personal bundle to get this done by the best guy around.

The nice lady at the insurance company tried to help me find someone else, but all she could come up with were a bunch of doctors in northern Jersey, across the river from New York City.

Eventually, though, I found a website that listed pretty much all of the surgeons in New Jersey who do this. There's even one who heads up a department for this at a major hospital near where I live. I could go with him, but to be honest he doesn't seem to have as much experience as the other guy.

Owell. Now I get to decide.

I think I'll think it over for awhile.

p.s. It snowed like hell this morning and our offices are closing at 3:30 today (45 minutes from now). It's time to look busy before I go catch a bus.


Bev Sykes said...

Oops. Well, anything worth having is worth working for and it looks lik you're going to have to work more for this than you expected.

If I were to have this procedure, it would also involve EXTENSIVE plastic surgery after the weight was gone, which is another reason I will probably never do it.

SteveSchalchlin said...

Best of luck to you. All surgery is serious, so I support your choice to be very choosy.

JoyZeeBoy said...

Thanks, Steve.

I've always been picky about MDs (well, once I got sober and had a real job and had to pick doctors from a list provided by the insurance companies).

I check 'em out at both the AMA website and the NJ state attorney general's office (most states run a website like this -- which shows the doctors education creds plus whether or not they've had any actions taken against them).

But these sites can't show you the most important thing about a doctor, and that's his or her bedside manner. That matters a lot to me.

As for plastic surgery, Bev. Well, feh. I'm not doing this because I care about what I look like. I'm doing it so I don't wind up like Father Al, Aunt Mary, Aunt Nancy, Aunt Delia, Aunt Nellie and their sister, my grandmother, all of whom wound up blind and limbless in nursing homes for the last years of their lives as a result of Type II diabetes.

I'm doing this because God went to a lot of trouble to sober me up, to get me a job and to have health insurance.

I can't imagine that the "plan" includes pain and suffering when I am so clearly provided with options.