I have an appointment with Dr. Myron Brand on March 26 - he is in the same building where Dr. O was, but in a different practice.  He came recommended by someone  in my CCFA support group who has a problem J Pouch.  He is an IBD specialist, but at least he has seen and scoped J Pouches.  Probably not as much J Pouch experience as Dr. O but then again who really does, other than his mentor Dr. Shen, who isn't in CT.

Thank you both for posting here. I also saw DR  's replacement snd  my feeling are mutual. I cannot get a scope until end of March  and I am clearly still having issues. She gave me samples of calmoseptine and did an anal exam but could not look further in the canal due to spasms.  I was fine for exam and really wanted a further in office evaluation other than I received.
She also suggested a surgical consult as I requested my records before my appt as I am having a consult  my with surgeon out of Hartford Hospital next week.

  I cannot wait three months for a scope and I was also passed off the the nurse for my follow up. I have read she has the reputation for doing this.

I used to go to the practice above Yale Digestive Disease before my surgery. The GI I saw there left and had no joiuch experience.  He did, however consult with Byran ( misspell?) who was the Dr who recommended I go see the surgeon I am seeing next week at Ct Surgical Group for my jpouch surgery. I did not use this surgeon for my original jpouch surgery.

Our new GI knew I was going for a surgical consult and I never received my medical records at my visit although I requested them and she highly suggested I see one of their surgeons before I made any decisions as she  felt there were things they could do to help with my stricture if my next dilation did not improve symptoms.
On a side note ...Dr.  O never recommended Yale colorectal surgeons in all the surgical discussions we had.  Has anyone communicated with him since he left ? I understand he is still not practicing in NY as of yet. I already miss him.

Please report back your findings with your visit CT.  I understand he is on the older side and Dr O mentioned him but did indicate he could be closer to retirement age than his replacement at Yale Digestuve.
I am going to ask the surgeon for a gastro referral and I can pass it in.  I also looked up Ct top docs and I do believe a couple of GI 's in the practice above Yale were listed. dr O's replacement received the award in 2008 as her plaque is in the office waiting room.

I am going to email Dr O today. I will report back if he responds.

Good luck. Let's keep this conversation  going.

Dr O will start seeing patients in NY next week. Unfortunately the clinic does not accept my insurance otherwise I would have followed him. He does not practice at Beth Isreal for a couple of months.   My surgeon is out of NY also and did not accept any insurance. It's a NY thing.

Personally since I need annual scopes w biopsies, I have a very hard time trusting new doctors to pick at my jpouch. I may continue to see him for my annual scope.

I am surprised that Yale has no one good there.  Since you are not far from the City, what about Columbia.  I can get a name if you would like.  Also there is Mt Sinai. used to be a top IBD before Cleveland.  But I do know both are excellent.

 

Most of us had our surgeries at Mount Sinai but insurances are not going to cover NY doctors and furthermore, to the extent that anyone has a surgical issue, a lot of the surgeons at Mount Sinai and Columbia do not take insurance.

 

Yale has some good docs, but we are talking about J Pouches. Dr. O was a great J Pouch specialist and all of us were going to him before he left for the greener pastures of Mount Sinai as indicated in my prior thread:

 

https://www.j-pouch.org/topic/n...octor-in-connecticut

Jeanne

 

I would not recommend Hartford Hospital. They are in the news today for contaminated scopes, this does not surprise me. I had seven surgeries there and witnessed the ridiculous decline in service. It is not the same hospital where I had my first surgery in 1993. My 2010 surgery will definitely be my last there.

 

There are two excellent j-pouch surgeons at the Ct Surgical Group both around 60 yrs old. One of the surgeons did six of my seven surgeries. He is exceptional, but burned out lately from doing as many bariatric surgeries as humanly possible (likely a good retirement plan builder). The other surgeon has had a personality bypass. I would say it is definitely worth a consult with either surgeon, but run if they take out their scalpels.

 

If your stricture is at the anastomosis site, like mine is, get a few consults before surgery. After all, this stricture is from scar tissue, which is from surgery in the first place.

 

Feel free to private message me is you need more info. Let us know how the consult goes.

I'm new at this.  I can't believe Mt Sinai and Columbia don't take insurances!  Wow.  Amazing.  My son had his surgery for his j-pouch at Robert Wood Johnson in New Brunswick, NJ.  It's just far enough to be pain to get to from CT but there are at least three doctors that do pouches, scope pouches and are good.  From what I understand it's a good program.  I've read that Hackensack has a GI program, but was told it's not that great for what we are all looking for.  There might be someone at Morristown, I'm not sure but might be worth looking into.  Morristown is at least associated with Robert wood medical school, so that, in my opinion, is a good thing.  I know of a gastro guy somewhere in Westchester who is from Robert Wood, used to be my son's doctor.  It's an Armenian name, don't know how to spell but it's something Manukian.  I heard he went either to Rockland or Westchester county.  Someone, somewhere, has to know something.  Shouldn't have to travel the entire east coast just to find a good doctor.

 

It's mainly a NY thing, these doctors are very busy and they and their staffs cannot be bothered with having to deal with insurance companies.  Going back to 1992 when I had my first of 4 surgeries the predecessor to Manhattan Surgical Associates did not take any insurances and they still don't.  Reason is if they had to deal with insurance issues they would not have time in the day to do surgery and their staffs are much too busy to be bothered.  They let their patients deal with insurance, or pay themselves.

 

However the issue now and here in this thread is whether any Connecticut based health insurance plan will pay for a J Pouch specialist in NYC and the answer is NO! This is actually how I found Dr. O in the first place.  I challenged ConnectiCare, my then insurer, which wouldn't pay for my then NYC specialist I was going deeply out of pocket for, to locate a suitable J Pouch specialist in CT they would pay for.  They sent me a letter and identified Dr. O.  That was in 2010. But now Dr. O has left CT for NY, and we- that is, Jeane, me, Grieving Old Pouch and several others, are stuck as Dr. O has left us.  Anthem will not pay for anyone in NYC, it's not happening.  I already had this discussion with them.

Wow!  I'm so sorry to hear this.  And I'm glad that I didn't go in New York and stuck close to home.  I guess we have been very fortunate.

 

 

 

But most off all of the NYC surgeons will accept Medicare.  I really think it is more of the fact that they don't have to accept as large of, or any discounted payment from the insurance companies.  It's just a way to stay more profitable. I haven't dealt with any of the Mt Sinai doctors since the ACA went into effect so things may have changed since then.

I would have had surgery sooner if I could have found a surgeon who accepted my insurance at Mt Sinai and a surgeon that I want to use, I was looking for a surgeon who had a lot of experience. 

 

Last year I had surgery at NYP Cornell and the surgeon accepted my insurance, he was also the Chief Surgeon for the entire hospital.  My GI at NYP Cornell also accepts my insurance so no more paying out of pocket like I had to at Mt Sinai.

I guess they have the demographics to behave this way.  It's outragious.  They can't possibly be any busier than Cleveland, Mass General, Hopkins, or another large university hospitals and they all take insurance.  As a Jersey Girl, I can honestly say, sometimes NYers have a shi*** attitude!  

The insurance companies vary a lot. Sometimes they demand discounts that seem unreasonable to to the doctor. As a simple example, docs used to conveniently do lab tests in their offices, but the insurance companies started paying less than the cost of the chemicals needed to perform the tests.

My impression was that the NY surgeons did not want to deal with the insurances or waste the time of their staff dealing with insurances.  This was a blanket office policy and they asked the patients like me who had insurance for "out of network" coverage to "deal with it on your own."

 

This way of doing business is predicated on supply and demand economics.  You have come to them for surgery and if you want the surgery you do business their way and play ball their way.  Many of the better surgeons in NYC operate this way and by doing it they make more money.

 

Although many of us have these noble notions of Doctors being there to help you, they are in business to make money.  In demand, highly respected surgeons are very busy and if they do not do X amount of surgeries a week because they are on the phone with insurance companies fighting over bills, they don't make money.  They have to pay high overhead to rent in Manhattan, pay their staffs to keep the office going, pay their high malpractice insurance premiums, plus of course make lease payments on the obligatory BMW 5 series vehicle with which to navigate through Manhattan traffic with power and style.

 

I fight with and for insurance companies every day, so part of me says I can't blame them. It's a tough gig.  I have small crappy personal injury cases and with certain insurance companies you have to go on the warpath just to be paid peanuts on the file.  These Doctors have simply rejected wanting to go onto that battlefield.

 

I agree. Outrageous or not, if there are enough patients willing to do the insurance gauntlet themselves and keep those doctors busy, more power to them. I have heard it described not as about "making money" but about how they want to spend their time. Those who have enough patients to fill their plates without the insurance hassle state that it allows them to devote 100% of their time to patient care. I get that, but it also carves out a large population. Oh well. We all cannot have the best of the best of the best!

 

I guess that is why I like the Kaiser format. Everything is in house. Lab, x-ray, pharmacy, surgery, vision services, etc.. There is no pre-approval by the HMO. Doctors are given guidelines but are given authority to make decisions. They get bonuses for keeping their patients healthy. It is not perfect, but so far I have had great doctors, many of them from Stanford and other renown centers. They come to Kaiser because they do not have to hassle with appealing to insurance companies. The trade-off is that I cannot travel anywhere I want to pick and choose my providers.

 

Jan

I get it, dont agree with it.  I think we also forget, that while these people are doctors, it's also a business.  And yes, rents and insurance are extremely high in the City.  I was lucky a number of years back. I'm was diagnosed with a Cancer that no one had seen in this country. ,let me tell you, the New York docs were lined up on Park Avenue to see me, my slides, etc.  so were doctors all over the country !  Since they wanted to see me, obviously insurance didn't come into the equation.  Funny how it works when they want to see you, they spend all the time in the world with you and don't charge a thing.  My story did have a positive outcome and I'm still here!  My Cancer had been seen in 25 other women in the world, it was kinda rare.

Wow! Glad you did so well with your cancer.

 

Yeah, medicine is a business. Sad, but true. As far as I am concerned, doctors who don't want to deal with insurance, hire staff to deal with insurance, or work for an organization that handles it, fill a certain niche. Not my niche. I would not consider going to one, no matter how well recommended. I want to eat and pay my other bills. 

 

There are a lot of great doctors who do take insurance.

 

Jan

There are some doctors who don't get involved with any insurance companies, as discussed above.  Much more common are ones that don't have contracts with all of the possible insurance plans. Each plan has its own contracts, policies, fee schedules, etc. "Doesn't take *my* insurance" is very different from "doesn't take insurance," at least if you're offering information to people with various plans.

Isn't most of the insurance stuff now handled electronically and by computers?  I walk into an office, they take my insurance information submit it and have a response/approval back in less than 30 seconds. 

 

Even most pharmacy scripts are handled electronically.  Sometimes before I check out of the GI's office I am getting a text that my new medication is ready for pick up that he just wrote me.

 

I understand that appeals and procedures are mainly manual processes but I just don't buy the argument anymore that dealing with insurance companies is too complicated/time-consuming to accept major insurance insurance.  If they don't pay enough then that's a different argument and should be negotiated....but that is probably another thread.

Little different with out of network coverage so we are talking about apples and oranges.  In this thread we have an issue of people from Connecticut treating in New York but getting out of network coverage for surgical procedures that cost vast sums of money.  There is no such thing as automated approvals for complicated surgical procedures even if it is in network.

 

Furthermore most of the health insurers in Connecticut, and I have been through 3 or 4 of them, limit in network benefits to Connecticut providers.  I know of only a couple of Connecticut surgeons who are competent to look at J Pouches and if I wanted surgery I would have to go to New York where I have had all 4 of my surgeries.

 

Anyway, we can't argue against reality.  Reality is that many if not most of the surgeons who are experienced and highly competent in NYC do not deal with insurances, period.  It is not a question of accepting them it is WE DON't DEAL WITH THEM, YOU DO. This has also been posted about in many threads on this board about NYC surgeons in the past.

One other thing: insurance fraud in NYC is off the charts and it is therefore heavily regulated which is another reason why the Docs there don't want to deal with it.  You touch it, you get regulated. My friend is an agent with the FBI's insurance fraud unit and all they do is investigate health insurance fraud, much of it targeting Medicare.  There are myriad reasons for Docs not to want to deal with insurance that apply only in NYC and are way beyond the scope of this thread.

Yes, but all the NY docs accept medicare and not private insurance.  Not sure if that is a legal requirement or not. I personally think these guys are in it for the money and yes they do have high costs but they also triple and quadruple book patients with 3 plus wait times. I have waited more times than I can count for a non par surgeon for three to four hours or more for an office visits in NY. It incenses me to be honest, so I have moved my care to a surgeon and GI who accepts insurance. Only wish our prior GI's facility accepted my current insurance as I would still make the trip even if there were a wait. 

I went to see Drs. Gelernt, Gorfine and Bauer (none of whom accept insurances) and endured long wait times in their office and it took months to get appointments.  However, these 3 were/are among the best of the best in NYC along with Milsom who, from what I heard, also does not deal with insurance.

 

I believe it is a combination, they don't have the time to deal with insurance and perform surgeries as there are only 24 hours in the day, AND they want to make money after they pay the admittedly hideously expensive costs of doing business in midtown Manhattan where rents are obscene even for tiny, hovel like spaces.  Just look at this, the tiny little apartment that President Obama rented in 1981 when he was a student at Columbia, on 138th Street I believe, is now $2400 a month, which is well below the median rental of $3,250 per month in an area that is nowhere near midtown:

 

http://www.today.com/money/ren...apartment-8C11070404

The insurers' practices vary, but they often behave horrendously toward doctors, in terms of abusing their time, challenging their integrity, and undermining their professional judgement. If they actually served as a thoughtful, qualified second opinion things might be different, but the insurers' motives tend toward the corrupt, and their methods are unspeakable. I'm not at all surprised that doctors who can fill their practices without exposing themselves to such unpleasant behavior jump at the chance. I don't think it's primarily a reflection of greed, though it is true that doctors who don't deal with insurers surely spend more time doing work they can bill for, without accepting a large discount, but presumably for equally ill patients.

 

Those of us with out-of-network coverage, which costs more, always have the option of submitting those claims ourselves, and it's really not such a big deal, except that it exposes us to our own insurers. We tend to be disappointed, however, with how inadequate that coverage turns out to be.

 

Doctors don't have to participate in Medicare, but it's all or nothing, and the elderly are a very important source of patients outside of pediatrics and obstetrics. Most won't cut that cord, even if they'll eagerly choose to never speak to Anthem or United again.

Because I am a soldier on the battlefield between insurers, insureds, third party claimants and Doctors, I can say there is a lot of truth to what Scott says.  There is an "us against them" mentality that often pervades on both sides, and since I am one of the few attorneys who is often on both sides, I get to see it and hear it in the flesh.  Doctors are frequently spoken about in very unflattering terms based on reputations that they have developed from any of a number of criteria, including the quality of their reporting, their eagerness or lack thereof to perform surgery, the perceived excessiveness or lack thereof in their disability assessments, or work capacity assessments.  I know one doctor who has a reputation for being an aggressive advocate for surgical treatment, and is called a certain name due to that reputation.

 

How this type of conduct manifests at the lower levels of an insurance company is largely a by product of management philosophy.  A number of years ago, I was called upon to get involved in a subrogation claim between two insurance companies over a homeowner's loss and payment for same.  In reviewing the file that was sent to me, I noticed that an agreement to accept liability had been set forth in an email from one low level insurance company employee to the similarly low level employee at the other company.  The acceptance of liability couldn't have been any clearer in a pithy email.  6 months later when the promisee company called the promisor company asking where was payment, a supervisor picks up the file, and promisor company that had accepted liability told the other to go pound sand.  Long story short, I file a lawsuit from hell and within days I get a call from someone very, very high up the food chain in the sued insurance company, who made it clear to me he wanted to settle the case and asked for an extension of time to respond to the lawsuit so he could get one of his more senior staff litigation attorneys involved to conduct the settlement negotiations. I granted the extension and the case was settled within a week for a sum that included the full subrogation claim plus my attorneys fees plus costs (there was a bad faith claim and other statutory claims so I could recoup my attorney fees).

 

When the smoke had cleared, the settlement docs were signed, and the case was over and withdrawn and in the rear view mirror, I ran into a friend of mine who was in house counsel at that insurance company, who had some familiarity with the lawsuit.  I asked him how on Earth something like this could have happened (it's very rare in my experience which is over 20 years litigating this stuff).

 

He then put the blame on the insurance company's management, telling me that "they really don't teach their new employees how to adjust claims, because they think you can train a monkey to do it.  And we have had some other stuff like this happen that hasn't spilled into litigation yet."

 

To be fair I work for some insurance companies that are very good at what they do, are very professional, and their senior adjustors know the files and the law and when they call you they ask some damn good questions.  Most of the senior people at insurance companies who are very good at what they do are "true believers"- they don't believe anyone deserves a nickel of insurance money, but they will give you a number of good reasons why.