Dr Samji and insurance

I have a phone consult appointment with Dr Samji in two weeks (YAY). His nurse had me work with the scheduler but the scheduler doesn’t work with insurance. Can anyone who has seen him in the past year or so tell me who I need to be contacting for insurance coverage? I’m happy to call my own insurance company but I need the CPT code for coverage. Oh, and I live in WA so this will be an out of state consult/surgery. If anyone has insurance advice, please share.

Dr. Samji bills the surgery as a “mini craniectomy” or at least he did when I had my surgeries. Kim, his medical assistant, should be able to direct you their insurance person. She’s very quick to reply to emails. You should email her tonight or tomorrow & ask for the contact info for the person who deals w/ insurance in their office.

Hi! I am also from WA and Dr. Samji did my surgeries. I called my insurance first, I use Regence Blue Shield. Dr. Samji was ‘in their network’. There was a little back and forth in calls, so it’s best to keep notes and just plug away. There was a co-pay - but since my condition was beyond ‘elective’ it was returned to me the following year. Let me Highly recommend Dr. Jill Ghormley in Bellevue. She first discovered my ES and is an expert with cold laser treatments. She has been a God send with my healing journey.

Thanks. I used to have Regence insurance but had to switch to Kaiser this year and they are being less than helpful. It’s not looking good for them covering the out of state treatment as they think I should be able to find someone in state. They did approve the surgery for an ENT locally but that ENT decided I needed a more extensive surgery than he could do. I’ll have to consider paying out of pocket which is not ideal at all given that I have no clue how much that may be.

Dr. Samji’s cash price is considerably less than he charges if you go through insurance. I only know this because I checked this out for a gal from Malasia several years ago & compared it to what my insurance was charged for my surgeries). Kim - his med assistant should be able to give you that info.

Seamom disputed w/ the Kaiser system here in CA as they refused to pay for her surgery w/ Dr. Samji. She did go ahead & proceed w/ bilateral surgery w/ him. She subsequently pursued Kaiser’s denial of payment at a higher level, but I don’t know what ever came of that. You could try privately emailing her to discuss how that’s going for her.

Thanks; good to know his cash price is cheaper. Do you know if Seamom lived in CA when she had the surgery? Kaiser’s problem with mine is that Dr Samji is out of network and that I would need to find someone in WA or OR. But, at this point, I prefer Dr Samji given my complications.

She lives in CA & Dr. Samji is not a Kaiser doctor. He is in private practice here thus the trouble seamom had & you will have. Kaiser offers a good service but lacks flexibility when it comes to needing to go outside their network. I will warn you that even the cash price is high. I don’t want to give any numbers since it’s been a couple of years & they won’t be accurate at this point.

I can tell you there will be 3 different charges - 1) Dr. Samji’s fee 2) Anesthesiologist fee & 3) Surgery center fee. All of these do charge less for cash paying patients, FYI.

Thanks. Technically, they go through a company when out of state that he IS in network with, but they won’t pre-approve anything like that. Basically, anything planned needs to be done in network. The other is to be used if I were to just be in CA and got sick or hurt. It’s frustrating because I originally went with Kaiser because the initial surgeon I was working with and had scheduled surgery with was in network with Kaiser and not with Blue Cross/Clue Shield. I’ve read the surgery totals will likely be in the $25K to $40K range which sounds insane, though doesn’t surprise me. But hey, at the rate my pain is going, I won’t make it to retirement anyway, so why not dip into that.

Let me ask my sister who works for Kaiser, what can be done. She’s in charge of a huge section of nurses and is a very smart lady. <3

Ok, so you twisted my arm hard enough…When I had my surgeries 11/14, 8/15), I added up charges & came up to $20-25K each (can’t remember exactly); when I checked the cash price for anesthesiologist, surgery ctr & Dr. Samji it was about half that amount. I would doubt w/ all the rearranging of insurance by our government & new laws, etc., that the price is still that “low” (tongue in cheek), but it would be worth it for you to ask. I agree, that ES pain/side effects corrodes one’s life, & if they’re bad enough, it’s worth whatever it costs to get rid of them.

Thank you MusicGeek and Isaiah_40_31.

Hi @georgiagirl,
Hey I heard back from my sister. She said she really didn’t know much; but she asked if maybe your primary physician could advocate for you? Another option is to talk to Customers Service (if you haven’t already done that). She told me that if a referral has been denied, you can appeal it. There is a formal appeal process. She wished she could be more help.(She’s witness my journey)

I spoke with my husband about it. We used to have single sole proprietorship type of insurance through Regence Blue Shield and just switched what type we have with because of the changes they made with what policies they allow in Washington State. My husband’s business created a new group that I am now part of as well as his employees. After he went through the work, he said if he were you, he’d try to get back on to Regence Blue Shield since Dr. Samji is in the network (last we knew). I’m sorry for the troubles, hang in there.

Thanks MusicGeek. Yes, I’d like to get back on Regence or Premera. I don’t think I can switch until next calendar year though at this point, unfortunately.

I’m very sorry about that @georgiagirl. Perhaps the appeal process could work for you? Let me know if any of your doctors would like to speak to me or my doctor who’s been through my journey with me. Private message me if that’s the case. Hang in there.