At Sat, 20 May 2000, Bernie and Beverly Doucette wrote:
[] MONEY AN ISSUE? INSURANCE AN ISSUE?
" Because insurance company's across the USA have set rates ( ceiling rates ) on most surgical procedures...and they set a rate for that procedure based on what they think it SHOULD cost...so in a normal " Adhesiolysis " procedure, the usual rate across the board is about $2500 total! Now that means that no matter who the surgeon is, or the facility where it is performed in, the insurance company will pay no more then that amount...no matter how long the procedure is, no matter how skilled the surgeon or reputation of the surgeon, that is the amount they pay as that is what they feel that particular surgery should cost. That rate is based on the amount of time and the " importance " of the adhesiolysis procedure.
" Most insurance company's feel that an adhesiolysis procedure SHOULD be able to be performed in about 1.5 - 2 hours TOPS!!! Why? Well, as you know, MOST surgeons and DR's do NOT feel that adhesions in and of themselves are a disease or cause a problem...unless you obstruct...so it is their impression that a surgeon should be able to go in, laparotomy or laparoscopically, and simply slice them apart...but they also feel that it should be or is usually done in relationship to a cooperative surgery such as a hysterectomy, appendectomy or some other type of surgical procedure...and if you look and listen to other ARD sufferers, there has always been another reason or procedure done when they had an adhesiolysis...know why? Because the surgeon gets more money by performing another procedure with the adhesiolysis!! When they do a " diagnostic " procedure ( which is their way of being able to perform an adhesiolysis only ) they get paid very low rates for their time...and adhesions take time...so most Dr's do the 1.5 - 2 hour adhesiolysis and then close you up or take out an organ or do a resection etc.!! Not only will they not do a good job, but the hospital will not allow any more time for one as the money paid from the insurance companies is not enough to compensate for the use of the operating room, the anesthesiologist's time, etc...so everyone loses, mostly the ARD patient!!"
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[] MY (Helen D.) ADHESIOLYSIS EXPERIENCE:
I want to share the experience I had following a diagnostic laparoscopy in 1997:
After 27 years of seeing doctor after doctor after doctor...I finally found a gynecologist, who listened to me and sincerely believed that I was suffering from chronic pain. He told me that, from the description I gave him about my symptoms, to him my symptoms sounded like either adhesions or endometriosis...but he felt pretty sure that adhesions were the cause of my pain. He told me that only a diagnostic laparoscopy would provide the answer. This was the very first time I had ever been offered a diagnostic laparoscopy!!!
So on August 1, 1997 I was scheduled for Same Day Surgery at a hospital in Minneapolis, MN. At the very beginning of this surgical procedure, my gynecologist had great difficulty in inserting the laparoscope through my navel, the usual first point of entry. Instead, he had to start the procedure just above the pubic bone.
What was my diagnosis? I had massive adhesions the full length ( 7 inches ) and 4 inches across the surgical incision from the laparotomy I had undegone in February 1970!! These massive adhesions had attached my omentum ( The omentum serves as a protective barrier between the intestines and the abdominal wall. ) to my abdominal wall...almost as if my omentum had been super-glued to my abdominal wall!!!
I requested a copy of the video of my surgery; which really proved what my surgeon was up against. I watched the video and I was able to see the difficulty my surgeon was up against. Remember, this was a diagnostic laparoscopy...and he had to lyse these tough adhesions ( They were very mature because they were 27+ years old! )before he could begin his examination of the rest of my pelvis.
As he cut through these adhesions with the use of scissors ( which cut and cauterize at the same time ) I noticed that as a result of the cauterizing, the liquidized fat dripped into the pelvic cavity. I do not know if this substance would be irritating to the pelvic organs; BUT...just before the surgeon freed the adhesions from my abdominal wall, I saw a thick adhesion, which had a blood vessel running through it. When he cut through it, I noticed that it bled...causing blood to drip into my pelvic cavity. Blood is a known irritant, which can cause scar tissue to develop.
Because of the massive adhesions, I was kept in the hospital overnight...on intravenous antibiotics and pain medication. Other than the expected pain from surgery, I definitely felt better than I had in a long, long time. I had such great hopes that I would be pain-free......UNTIL on the 10th day I began to feel the return of pain; but I did not get too concerned about it. Six weeks post-op I mentioned this to my gynecologist...but he did not show any real concern. Not being a very assertive person, I did not make an issue out of it...
...until several weeks later when my pain level was beginning to get out of hand. Since I lived at some distance from Minneapolis, I wrote to my gynecologist to ask what he would suggest that I do...actually thinking that I would be given an appointment date. Two weeks later I received a call from one of his office nurses. I don't remember the exact words she used; but she told me that the doctor did not want to see me!! I asked if I could make an appointment...but again she said that the doctor did not want to see me. I was shattered!!!!!!!!!!! I could not understand why this gynecologist wouldn't see me.
It took me almost 6 months to find out why I had been refused further care from this gynecologist!!! During those 6 months I spent alot of time online participating in the Endometriosis Forum ( http://forums.obgyn.net/endo/ ); because I needed a place where I could vent some of the frustrations and feelings that had come over me as a result of being denied care by my gynecologist. It was through this forum, that I learned the answer to the "cold shoulder" I had been given by my gynecologist's nurse ( who was acting in behalf of my gynecologist.)
This is what I learned: Because I am a Medicare patient - with Blue Cross Blue Shield as my supplementary insurance, Medicare did not pay what my gynecologist was asking!!! My gynecologist had to accept what Medicare paid...and then my gynecologist had to " write-off " the balance. In other words he did a difficult surgery but was not paid adequately!! I know that the same thing happened for both the hospital and the anesthesiologist - both had to be satisfied with what Medicare paid them. Neither the gynecologist, the hospital, nor the anesthesiologist could bill me for the unpaid balance!!!
Another thing I learned was that there are certain hospitals in the United States which WILL NOT ACCEPT MEDICARE PATIENTS!!! That's right!!! The low payments, which Medicare reimburses doctors and hospitals with, is intended as Medicare's way of protecting seniors from excessive medical charges...and, unfortunately, preventing seniors from seeking the very best professional care.
So I can understand why many doctors do not do diagnostic procedures...but rather look and wait for another better-paying surgical procedure to arise.....SUCH AS HYSTERECTOMIES...and many hysterectomies are DONE FOR THE WRONG REASON!!
I read an interesting book by the name of " Women and Doctors "...which was written by a male gynecologist. What I found really surprising was that this male gynecologist was actually advising women to seek medical care from female gynecologists...rather than from male gynecologists. His reasoning is that female gynecologists understand women and their medical problems far better than male gynecologists do. When in the care of a female gynecologist, women can avoid certain male gynecologists who "prey" on women by suggesting surgical procedures, such as hysterectomies, when a hysterectomy is not warranted at all. Don't let this happen to you!! Learn as much as you can a medical problem, which you may have; and consider seeking second opinions before undergoing the knife!!
[] NOW CONTINUE ON WITH BEV's MESSAGE:
" Now, by asking for the $3000 up front in Scranton, this assures that in the event the insurance company doesn't pay for a lengthy adhesiolysis procedure if your very involved with adhesions and the surgery takes 4 - 10 hours, and trust me, they will not pay for that...then DR. Redan, or Dr. Reich have at least been compensated for their time, skill and expertise in lysing adhesions. If your surgery is within a " normal " range of time, and all the pre-payment is not utilized, you get all or some of it back. I had a 5 hour surgery, and was refunded a decent portion of it after my surgery! The $400 consultation fee is just what you pay for the experienced specialist if you want them. A person wouldn't think twice if you were talking open heart surgery...you would go to and pay for the best Dr. in the world if it meant your life, right...well this is your life too, it is just that it is under-rated as a problem unless you're the victim of ARD (Adhesion-Related Disease)!! Money spent is scary, sure, but money is nothing without the life to spend it on!"