???s - Doctors in Houston - UHC - 2nd insurance - qualifying

cl_tx_42 · 08-04-2006, 10:06 AM

Oh the questions I have. I am just deciding to have LAP-BAND^® surgery. I was always thin until about 8 years ago and now I HATE being fat. I hate shopping because nothing fits, etc., etc.

Here are some questions for those of you who have had the surgery or anyone who can help.

Doctors - I was initially going to go with Dr. Spiegel because I live in Beaumont...but I've heard so much about the cattle call, I'm not too impressed with that.

Then, I saw where Dr. Spivak no longer accepts United Healthcare.

Insurance -
I have United Healthcare Choice Plus. Can anyone give me the names of doctors that they have used that have this plan? of course, only if it is a doctor you liked :~) And, if you could throw in the total cost...that would be great also!!

Secondary Insurance-

I am also on my husband's plan. He has PHCS. How does that work with insurance. This is the first time I have been on two insurance plans.

With UHC, my deductible is $1000 then they cover 80%. My husband's insurance is the same.

Qualifying -

I am afraid I will not qualify...which would be really sad for me :cry . I'm 5'5" and weigh 218 lbs. My BMI is 36. But here are my exclusions, I have hypothyroidism, acid reflux. I did have my gallbladder removed (does that count for gallbladder problems?). I had gestation diabetes with 2 pregancies. Last couple of times I have had blood work done because of my thryoid, my TSH was a 38 and my cholosterol was high. Blood pressure is borderline 130ish/80.

Thanks for all of your help.

HeatherGurl · 08-04-2006, 10:11 AM

Dr. Spivak does take UHC... if you have out of network coverage. He is just no longer in their network.

barbara465 · 08-04-2006, 11:31 AM

It all depends on what you want for aftercare as to which doctor you chose. I think Dr. Spiegel is an excellent surgeon, just not a good after care. I hear Garth Davis is good at both, in UHC network, but hasn't done as many lapbands. He did lots of gastric bypasses I believe. Fills are the real issue. I like the fact that I can go to the surgicenter and get my fill. I don't have to see Spiegel. Davis uses Methodist hospital which is in network.

I have UHC and they approved me without anything from my PCP. If they did, they did it without my knowledge. Spiegel handled everything. It just depends. Let the doctor you chose submit to insurance and see. If UHC questions it you may have to jump through some hoops, but they will help you.

If you go out of network you just have to pay the out of network deductible and then the % they handle for out of network.

Hope this helps.

WANTING2LOSE · 08-04-2006, 03:25 PM

I jest had my surgery on July 26 with Dr Garth Davis. He is in the Medical center. He has been great. He did my LAP-BAND^® at 0900 in the AM and I went home the same day. He is very big on follow up after surgery. I have United Helth Care. I had no problem receiving approval. My BMI was 40. Overall my experance with him has been very good. I went for my follow up visit yesterday and every thing looks good. I go back in a Month for my first fill. I have lost 15 pounds so far (1 week). I have not been hungry so far. Good lock!!

CCBSTX · 08-04-2006, 04:02 PM

My surgon is Dr. Chang in Victoria, TX. He accepted my insurance, which is the same as yours! Of course it outside of Houston (1-1 1/2 hours). The hospital is awesome and the surgeon is also. Here's his number 1-800-555-1555. This is a non-cattle call atmosphere.

I also did a consult with Dr. Spivak. He's has a stellar reputation. Call his office and find out the "scoop." Things change all of the time. I didn't choose him because of the travel time, involved for me, with followup care/fills.

bswint · 08-06-2006, 06:43 PM

I am scheduled for surgery on Aug. 25th. I am using Dr. Spiegal. I understand what you mean about the "cattle call" but I wanted the best surgion avail. Also note that Dr. Spiegal is no longer an "IN NETWORK" provider. He still accepts UHC, but it will be an out of network provider. My insurance doesn't pay for anything having to do with weight loss, so I am now a self pay.

NewSho · 08-06-2006, 07:55 PM

Like with any surgery, it's important to find the doctor who is right FOR YOU individually - not who's right for your friend, neighbour, or someone on TV.

Having done The Most is not exactly the same as being The Best.

As always, Good Luck!

Larissa · 08-06-2006, 08:26 PM

I had Dr. Spiegel do my surgery in June and the reason that I went with him was because he is considered one of the "best" in Houston. But after my surgery, I felt the after care left a lot to be desired. So when it came time for my husband to have the surgery this past Wednesday, we went with Dr. Spivak. I can honestly say that I think Dr. Spivak seems to me to have a much better bedside manner and gave my husband pain killers on the day he left the surgicenter where as I had to beg for them one week after the surgery in Dr. Spiegel's office after I was still having intense gas pain. For me, if I had to do it over again, I would probably pick Dr. Spivak.

With all that said, I think it is a personal decision. From where I stand now, after having my band for 6 weeks now - I can honestly say that I am not sure it really matters which doctor I would have chosen now - as I will probably not see Dr. Spiegel that much again, and my husband will probably not see Dr. Spivak again. (Simply because it seems to me to be quicker to get in for a fill when you go with the techs than with the doctor himself.) They are both seem to be very competent. And one last thought, as my husband and I were both self-pay - it sure does help that my husband has free fills for a year because Spivak patients get them for free, whereas Dr. Spiegel only gives you the first fill for free.

faybie · 08-07-2006, 03:19 PM

Wow. Thank you for your posts. I was trying to decide on which Dr. to use in Houston and this thread has been very helpful. I have an appointment coming up with Dr. Spivak. Bedside manner and follow up care are both very very important to me.

I really appreciate those that took the time to post your experiences about your Dr.'s.

~faybie

DBarrett8 · 08-14-2006, 10:22 PM

I was banded by Dr. Spivak in Feb using UHC insurance. Spivak required a $600 payment upfront prior to surgery. When my claim was processed, Spivak owes me $500 and will not refund it until his court case against UHC is heard. I had to call numerous times to find this out. His office only sent me a poorly written letter stating they were refiling the claim.
Now he does not accept UHC or does the surgery center that he and Dr. Spiegel invested in.
Spivak seems to be an excellent surgeon, but his aftercare leaves much to be desired...you do feel like you are part of a cattle call.....and now I am wondering where to go now..... If Spivak was really interested in his patient's well-being he would offer a solution to his UHC patients by finding a new doctor for them in Houston that will accept UHC for after-care service.

faybie · 08-15-2006, 04:24 PM

Wow Debbie,

I would be upset too if I had not received a refund. I am self pay so I will not have the hassles or any let downs from my insurance because it is not covered.

The amount doesn't bother me, because my husband and I eat out 75% of the time and it is usually a 3 or 4 course ordeal everytime (I have been having a love affair with fine dining). I know that over the next couple of years our dining out bill will significantly decrease.

Another thing that turned me off about Dr. Speigel is that when you are scheduling your appointment they let you know up front that they don't deal with credit cards or personal checks specifically CASH only. The cash only statement threw up a huge red flag and made me feel uncomfortable with his process.

barbara465 · 08-15-2006, 04:36 PM

My surgery was 2 months ago and neither the surgicenter or Spiegel have been paid by UHC. I was preapproved and had to pay Spiegel $2800, which included $300 for out of network fee. This was supposed to be my portion of the out of network. I was then not to have to pay the Surgicenter for their part or for fills the rest of the year. Surgicenter sent UHC a bill for $30,500 and Spiegel $7500. UHC is not paying. What a racket. I'm just sitting back and waiting to see what will happen. Meanwhile I've been to the surgicenter 3 times for fills and unfills and go again on Wednesday. I just tell them I've met my deduction and they don't make me pay a copay.

texasvixxen · 08-15-2006, 04:40 PM

I also have UHC through Methodist. My husband works for The Methodist Hospital, so my surgery was covered 100%. I love my doc - Robert Marvin. He was the first surgeon at Methodist to do the LAP-BAND^® procedure. He has a wonderful bedside manner & he has a wonderful staff. Good luck & best wishes!

DBarrett8 · 08-15-2006, 11:58 PM

Spiegel and Spivak's practices must have done something to cause all these issues with UHC. And now you say Spiegel is requiring CASH only. I would definitely find a more financially secure organization than theirs.

Good luck with your surgery!

bswint · 08-16-2006, 12:38 AM

Yeah I thought the same thing! I am scheduled for my pre-op 8/18/06 and my surgery is scheduled for 8/25/06. I am going with Dr. Felix Spiegel. I am a self pay so it's cash only for me, but It did strike me as odd that he accepts cash only and cashiers checks. I was a little put out when I went to the cattle call and it was all cash only. However, when I sat and listened to everyone and spoke privately with Dr. Spiegel($250.00 consultation) he said that he had been stung several times by people and insurance so I guess the only way not to get stung is by cash. I'm rambling, SORRRY! I am just scared to death of going into surgery alive and breathing, and comming out DEAD! I am going through with it, but it has caused me to look at my own mortality!