UHC and Dr. Spiegel

barbara465 · 04-28-2006, 08:49 AM

I just got the call from Dr. Spiegel's office that he would no longer be In Network with United Healthcare effective June 1st. I am scheduled for June 15th. The cost to me now would be $4500 for Dr. and $2900 for the Surgicenter. I am devasted. Who in Houston takes UHC? I don't want to change my date for surgery, but I don't want to pay this amount out of pocket. I am anxiously looking for a new Doctor. I was so ready for this surgery and then this setback.

mini_me · 04-28-2006, 08:59 AM

I was afraid this was going to happen...first Dr. Spivak, now Spiegel. I do not know of anyone else who would be in network with UHC. Look for "Gurly" formerly known as HeatherGurl. She always seems pretty knowledgeable about these issues.

Have you called UHC to ask if there are any other surgeons in the area?

Good Luck, and I am so sorry this happened.

LindaV · 04-28-2006, 10:14 AM

Hi Barbara,

Check with UHC to see if ther is another in-network doctor in your area. If there is not a network doctor in your area, UHC will often give you an "in-network provision" which means, you can use an out of network doctor but they treat it like it's in-network. Once you have the provision, even if the doctor bills for more than the contracted rate, UHC will cover it.

I had to go through this process here in Boise and my doctor has seen many UHC patients who have successfully gotten the "in-network" provision from UHC.

Good luck to you!

Angie C · 04-28-2006, 10:21 AM

I do not know a doctor in Houston but Dr. Jayaseelan in Dallas takes this insurance. My daughter has the UHC and only had to pay her deductibles.

3-15-04
-114lbs

SusanP · 04-28-2006, 10:35 AM

I am so grateful for this board. I use Dr. Speigel. I immediately used the information Linda V provided and got the ball rolling with UHC. My biggest concern is that in the paperwork Dr. Speigel gave me, "he is released from any responsibility for any problems with my LAP-BAND^®, or any other abdominal or stomach problems" if I switch surgeons. I spoke to Care Coordination and they have sent my request for review. They can't actually send it in until June 1st, but it's ready to go. Gosh, insurance is quite a pain. I wonder why he's not going to be with UHC???

Barbara465, I feel for you. It seems like it would be better to find a doctor who is with UHC so that your fills and follow up care/appointments will be covered. Let us know if you find someone!!! Susan

graceysnema · 04-28-2006, 10:44 AM

my brother had his surgery 2 weeks ago dallas fort worth area dr cook and benevedes he had uhc only had 30 co pay

LindaV · 04-28-2006, 01:10 PM

Barbara,

Most doctors do follow ups/fills for cash patients for the first year after the surgery at no charge. If you get an in-network provision for Dr. Speigel, he will be paid the full amount that he bills for, not the contracted amount so, see if he will charge you for fills/follow-ups.

Again, good luck with this whole process!

happyk · 04-28-2006, 01:31 PM

check with dr matthew st laurent, i have uhc. 281 921-1890

barbara465 · 04-28-2006, 02:41 PM

I love this board! I called Dr. St Laurent's office. I knew he was out of network, but he was my backup to Dr. Spiegel. Anyway, they will do the surgery if I pay my In Network Out of Pocket maximum. That happens to be $3,000. They will write off the out of network fee difference and the surgicenter is paid 100%. I am most confused, but if this works its OK with me. Originally I was going to pay Dr. Spiegel $1,200 and the Surgicenter $2,900. When Dr. Spiegel's office called they said I would owe them $4,900. I would still owe the Surgicenter $2,900. I think there is a little greed going around.

UHC wouldn't give me a provision so I was forced to either pay or change Doctors. I have an appointment with Dr. St.Laurent next Friday and we should be able to schedule surgery for June as it was scheduled before. My date will change, but the timeframe should be the same. I am also going to check with Dr. Spiegel's office on Monday as to why they can't do the same thing.

Thanks for the information and wish me luck that I can get this straightened out and back on track.

s

AlisonTexas41 · 04-29-2006, 06:21 PM

Call Dr. Dexter Turnquest in Houston. He's wonderful.

Momotrips · 05-24-2006, 02:14 PM

Hi, new here. I have an appointment with
Dr. Adam Naaman. He's in the UHC Network and they didn't balk when I called about the surgery either at UHC or Dr. Naaman's office. Dr. Spivak, of course is out of the question, now. Dr. Naaman looks good so far - he's a very experienced lap surgeon and is doing more and more lap bands, along with RNY that he's done for a long time, etc. and some general lap surgery. He teaches and has developed lap surgery techniques. He's at Memorial Hermann Memorial City. I hear he's quiet and businesslike, but very good and caring. Anyone know any more about him?

As for Dr. Spiegel, from what I've read he's kind of a "Cattle Call" setup and pretty mercenary, as opposed to Dr. Spivak who is supposedly very warm and cares about the good work that he does for people. At least that's what I've gleaned so far in all of my research. Dr. Spivak dropped UHC because they weren't paying enough percentagewise for his services. I hear that Dr. Spiegel is being dropped BY UHC - overcharging maybe? ($600 for a fill...)

I'm hoping to be banded by the end of summer/start of school. Has anyone here been banded on the Mustang Engineering UHC plan? How difficult were they to deal with - I've never had a problem with them before, but I've never had WLS, either. They keep telling me that it just has to get approved, but not that there are any pre-requisites. I'm getting pretty nervous. I could afford self-pay if I had to (OY!), but convincing my husband that he wanted to let go of the money for it would be another thing all together...He's kind of getting used to the idea, though. Wish me luck. I wish everyone else luck, too.

Melissa

barbara465 · 05-24-2006, 02:58 PM

Melissa,

Good luck to you. UHC didn't give me any trouble or required prereqs to get approved. However, I changed from Dr. Spiegel to Dr. Matthew St. Laurent and have to go through the process again. UHC said this was no big deal and would only take a few days once I selected a doctor.

My follow-up call says now that they can have up to 15 days to respond. I don't think I'll have a problem, but wanted to get all of this resolved before vacation. I am pysched for my surgery date and really don't want it to slip.

UHC gave me in network doctors names, but none of them I had heard of before. My new doc is not in network, but his charges were as if he was in network for me. My primary gave me Garth Davis and I confirmed that he was in network with UHC. I just didn't have any information on him.

Best to look at is the after care. What is your doctor's plan and does it seem reasonable to you? Some make you come back monthly and also visit a dietician. I like my new doc and feel much more comfortable with the whole process.

Good luck to you and hope you get approved soon.

Momotrips · 05-24-2006, 06:00 PM

Thanks Barbara. I just told my husband to chat w/HR about this to see if it's been done recently & how it went. It's a big company owned by an even bigger company, so SOMEONE'S bound to have done WLS. I wish I could have it done before vacation, but then I'd not be feeling great all week. Oh well...

Melissa

Jodie_Warner06 · 05-24-2006, 10:33 PM

UHC DID NOT cover my surgery with Dr. Spiegel, So we paid cash with a loan from the bank and I am SOOOOOOOOOO glad we did! I love Dr. Spiegel, I need to go there next week as a matter of fact..........but anyways, I love it there and Im glad I used him even if it did cost a lot. The results you will see are PRICELESS, I promise.

YellowRose · 05-27-2006, 03:05 PM

Barbara, I have found a Dr. that still takes UHC. Is name is Dexter Turnquest located on Red Oak. When I went into his office on Thursday, he actually sat in a chair and talked to me. Asked me a couple of questions and since I have already learned so much about the procedure he was impressed. I asked about his experience with the LAP-BAND^®. He has been doing the surgery since 2002, but since he also has a medical practice and not a factory assembly line he usually only does 50 bands a year. But since the other Dr's have left UHC because of greed, he has already done 45 bands so far this year. I really liked Dr. Turnquest, he was really human like. Maybe you would want to look into chatting with him, before you pay out the $3,000.00+ at another doc that does not take the insurance.