Frequently Asked Questions
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How do I get an appointment?
To become a client at Bespoke Surgical, we will first ask you for your insurance information in order to determine your coverage and eligibility. From there, you will be provided with a secure link to provide us with your basic registration details. Filling this out ahead of time negates the need for any fussy paperwork that you’re used to filling out in-office, and allows for the physician to see and treat you without the customary long wait times generally associated with going to the doctor’s office. At Bespoke Surgical, your time is just as important to us as ours is. Once we have registered you as a patient, one of our patient advocates will reach out to you immediately via phone or email to schedule your appointment. Click to here get started.
Have you had any prior testing done?
If you have had any recent testing done pertaining to your visit with Bespoke, please provide us with copies of the reports prior to your consultation with us.
Do I need to prepare for my consultation in any way?
No preparation is necessary for your office visits. Some patients utilizing our proctological services may prefer to cleanse or utilize an enema prior to their consultation, but we ask you not to do so as it may irritate the examination site or interfere with obtaining an adequate cytology sample should one be necessary.
Will the doctor operate on me during my initial consultation?
No. You will need to have a full consultation with a Bespoke physician prior to scheduling your surgical procedure. From there, you will work with a surgical coordinator to schedule your surgery at a later date.
What happens after my initial consultation if surgery is required?
After seeing a Bespoke physician for the first time, surgery is generally scheduled if required. A surgical coordinator will work with you to determine when and where your surgery will take place. Accommodations can be made for surgery within the same week as your initial consultation, or can be scheduled months in advance to suit your schedule. Bespoke will handle all insurance pre-authorization requirements for you, as well as determine a cost schedule if applicable. If surgery is scheduled, please see our Pre-Op section of this FAQ for details on how to prepare for your upcoming procedure.
I’ve had my surgery. Now what?
When booking your surgery, we will also book your necessary post-operative care appointment at the same time. Generally speaking, you should be seen for an in-office evaluation 3-4 weeks after your surgery. In some cases, longer or shorter lead times may be required. From there, your physician will determine a consultation schedule for any necessary follow-up appointments you may need.
Will I need any pre-op testing done?
If you are required to have pre-operative testing, we will obtain copies of your necessary blood work and/or EKG from your primary or referring physician. If you have not had recent testing done, we would recommend scheduling an appointment with your primary care physician to do so. Otherwise, we can send you to Beth Israel’s PACC walk-in testing center located at 10 Union Square East, Suite 3M.
When will I find out the exact time of my procedure?
The Surgical Pre-Admission Department will call you before 6PM on the day before your surgery with instructions of what time and where to report to on the day of your surgery. A Bespoke patient advocate will also be in touch with you during the scheduling process, updating you with details as they become available.
When do I have to stop eating and drinking?
Do not eat or drink anything 8 hours prior to surgery. If you have been advised by your physician to take your routine medications, you may do so with a small sip of water. Failure to abide by this mandate will unfortunately result in a cancellation of your procedure due to the requirements set forth by anesthesia. This is very important, as it is a large inconvenience to all parties involved in your procedure if it has to be cancelled.
What do I do about my routine medication schedule?
Unless otherwise instructed please take all of your routine medicines with small sips of water. If you are not sure which medicines you should take the morning of your surgery, ask your doctor or nurse. 7 days before the procedure you must STOP taking Aspirin or Blood Thinners (such as Coumadin, Plavix, Heparin, Lovenox, etc.). Discuss other medications with your primary care physician.
What if I get sick before my surgery?
If any change in your health occurs prior to surgery, such as a cold, cough or fever, please notify your surgeon and primary physician.
Are there any other requirements for my surgery?
NY State Law mandates that a responsible adult must be available to discuss your discharge instructions, sign you out of the facility, and escort you home. We ask that you please arrange this prior to your scheduled procedure. If unforeseen circumstances occur, Bespoke may be able to help in providing an escort to you. This, however, must be arranged in advance.
What are my immediate limitations after surgery?For the first 24 hours after surgery, you should not drive, operate machinery, make important decisions, or sign legal documentation. Also during the first 24 hours please refrain from both alcohol use and large or heavy meals.
How will my diet be limited?Unless instructed otherwise, advance as tolerated to a regular diet. In the beginning it is important to avoid heavy meals, spicy foods, and red meat. It is common to not have a bowel movement for 2-3 days after your procedure, so we recommend staying well hydrated and eating fruits and vegetables daily to help this process along.
How will my activities be limited?Gradually increase your activities, and do not overexert yourself to the point of fatigue. You will need to avoid stress to the operative site (such as lifting, pushing, and pulling) for 3-5 days. After this period, you will be able to return to your fitness routine per usual, avoiding focus on the operative site until you feel ready. Mild discomfort at the operative site is not uncommon, so be sure to listen to your body and progress at a rate that you won’t feel pain. For most surgeries, sexual activity can be resumed at your discretion but for certain cases, such as anal procedures, anal intercourse should be avoided until after your first post-operative visit.
How do I care for my operation site?
General Incision Care
Immediately following your procedure, you will receive post-operative incision care instructions from your surgical facility. Please review these, as they are specific to your particular procedure. For most general surgeries your incision site will have a dressing consisting of clear tape, gauze, steri-strips, and/or glue. The top dressing and gauze can be removed after 24 hours, but please leave in-place any steri-strips and/or glue that is present. These usually peel off on their own within 1-2 weeks.
Unless otherwise instructed, you may remove your dressing within 6-8 hours after surgery and have your first shower. To remove the dressing, we recommend submerging in a bathtub and removing the tape and gauze. If there is any internal packing, it will generally come out on its own. You may want to place gauze pads or liners in your underwear until any normal bleeding or discharge subsides. This will lighten and improve daily over the course of 1-2 weeks. Don’t be alarmed if you notice an increase in bleeding towards the end of your first week, as this is generally the time when scabs begin to peel off.
What medications will I need?
For the first 24 hours most patients will require painkillers, though these should be limited due to the common side-effects of nausea and constipation. To combat this, we recommend using a stool softener (such as Colace) 3 times daily. In place of narcotics, we advise many patients to take Tylenol or Motrin as directed.
In addition to the above, we advise patients that have undergone an anal procedure to take 2 tablespoons of milk of magnesia on only the first night post-surgery. Continue as directed with Colace stool softener 3 times daily. Balneol lotion can be utilized externally, as needed. Additionally, Calmol-4 suppositories may be used only if instructed by your physician.
How long until I’m back to normal?
While everyone’s healing process is different, the overall healing timeline is approximately 1-2 weeks. You may need to use painkillers for the first 24-72 hours after surgery, switching to Tylenol or Ibuprofen after day 3 (at the latest). Bouts of pain up to 2 weeks post-surgery are not uncommon, especially towards the end of the first week, but most patients will have a positive trajectory onwards from day 1. You will improve over time, with residual symptoms possibly occurring for as long as 4-6 weeks.
When should I call my doctor?
If you have a fever over 101 degrees or shaking chills, you should contact your doctor immediately. Additionally, if you notice swelling, bleeding, redness, numbness, drainage, or change in color from the incision site you should not hesitate to contact your physician. Severe pain, nausea, vomiting, constipation, or diarrhea are not common and should be cause for concern as well. If you feel this is an emergency and you cannot reach your doctor, dial 911 or head to your local emergency room immediately.
What will my bathroom habits be like immediately following surgery?
You may have trouble urinating for the first 24-48 hours after surgery due to the location of your anal surgery being in proximity to the prostate, the residual effects of anesthesia, and also the effects of pain medication. This can be normal. To counteract this try walking, urinating in the shower, and taking prescription pain medication only if necessary (we recommend switching to Advil or Motrin as soon as you can comfortably do so). Also it is common in the first day or 2 to feel the sensation of needing to urinate, but not actually having a full bladder. Again, this can normal. If you have had prostate issues in the past, do let us know. We may be able to prescribe something to help. If the bladder becomes so full to the point of bloating and discomfort and none of the above techniques helped you to achieve urination, please call us.
You may have trouble defecating for the first 24-48 hours after surgery due to the residual effects of anesthesia, pain medication, and the nature of the work that was done. This is normal. To counteract this keep extremely well hydrated with water and fruit juices, consume a diet with low proteins, and utilize stool softeners, fiber, and milk of magnesia or MiraLAX as a gentle laxative. Please do not use enemas or irrigation. If after 2-3 days you still have not had a bowel movement or are starting to feel bloated, distended, and in pain please reach out to us. You may drink a half-bottle of over-the-counter magnesium citrate to really get things moving but do be in touch prior to usage.
What makes the Bespoke Surgical’s private laboratory different from any other laboratory?
We are proud to offer a comprehensive series of general pathology and anal cytological testing that quite frankly nobody else is offering, and we’re looking at it in a way that nobody else is looking at it. Additionally, having a pathologist on-site allows for the complete continuity of care within your office visits, as well as the added benefit of direct communication between our pathology specialists and your referring physician and/or primary care doctor.
What types of pathology do you run?
We run a comprehensive series of anal cytology testing, as well as a wide range of anatomical surgical pathology and urological testing.
Will I receive a bill for my pathology?
In many cases, you may receive a bill or a statement from either Bespoke Surgical, AcuPath, or your insurance. This does not necessarily mean you are responsible for payment. If you receive any bills or statements for pathology, simply email a copy of them to email@example.com. We will help navigate you through the process and determine whether payment is actually owed.
How can I obtain a copy of my pathology report for my personal records?
For a copy of your report, email firstname.lastname@example.org or call (212) 206-1501, option 4. Generally, report requests can be fulfilled immediately upon request.
What if I need copies of my slides for an outside consultation?
Slide loan requests can be processed same-day. Slides are kept in-house, and can be leant out for a 30-day period. You will be required to come in to the office to provide identification, sign out the slides, and transport them to your outside consultation. We cannot send slides out on your behalf.
I want to become a client of Bespoke Surgical, but my insurance carrier told me that you are an out-of-network facility. What does that mean?
Insurance carriers often refer to our group as out-of-network physicians, much like many other specialty care centers in medicine. This does not mean we do not accept your insurance, but rather we do not have a contract with your particular health insurance provider. However, the overwhelming majority of health insurance plans in the New York City area have out-of-network benefits coverage. As long as your health insurance plan has out-of-network benefits (i.e., a PPO policy), you have the additional benefit of visiting a Bespoke physician. If you are not sure if your plan has out-of-network benefits, we would be happy to contact your insurance company and determine your level of coverage. Click here to have a Bespoke patient advocate securely verify your insurance benefits and eligibility.
What are the benefits of going out-of-network?
Many people choose a PPO policy because it provides more flexibility, which grants the ability to make optimal healthcare choices. The extra premium that you’re paying for allows you freedom of choice. The care that we provide is ideally suited for an outpatient procedure at a facility has the essential supplies, equipment and experienced staff to treat your particular case. Likewise, we choose to stay out-of-network with insurance companies to maintain our own flexibility in optimizing your treatment. By staying out-of-network, we can tailor our operations to suit our facilities, our surgeries, and, most importantly, its patients. In contrast, in-network providers are contractually obligated to adhere to insurance companies’ strict guidelines regarding where, when, and by whom a surgery is authorized to be performed—sometimes right down to the specifics of how a particular procedure can be performed.
What kind of bills and statements can I expect to see after my surgery?
After your surgery, you will receive a statement called an “Explanation of Benefits” (EOB), which simply itemizes the fees charged and the allowable amount covered by your insurance company. After receiving the EOB, you may subsequently receive bills from four entities: surgeon, facility, anesthesia, and pathology. Consistent with the EOB, these bills will show the amounts you are responsible for, as determined by your particular PPO insurance policy.
What should I do after I receive the bills?
The insurance may take between sixty and ninety days after your procedure to finalize all four claims, and possibly longer if an appeal is necessary. Upon receipt of the bills for your surgery expenses, please contact our various patient assistance departments found on our contact page (link). Our associates are here to help you understand your statements and will clearly explain how costs are derived. We realize medical billing and insurance may often be difficult to understand, therefore our comprehensive billing team will help double-check accuracy and assist in getting your insurance company to pay the fair amount and its fair share of your surgery expenses. In the event that your claim is denied or processed below your lower level of benefits, with your consent Bespoke Surgical will act as a representative on your behalf regarding your medical health claim determination, and explore any/all additional appeal options. Our goal is to help make your surgical experience as painless as possible, and we don’t want financial issues to get in the way of your physical recovery.
How is payment received?
With certain insurance plans, you may be issued a check directly which you are obligated to endorse by signing the back and submit to the appropriate entity that it is deemed for (this can be found on the EOB accompanying the check). You will then receive an invoice from each billing entity. This invoice will detail the remaining balance, which you may discuss with us at email@example.com.
Am I responsible for payment?
As an out-of-network provider, and with the potential of utilizing an out-of-network surgery facility, anesthesiologist, and laboratory, none of the parties involved have a contract with your health insurance carrier. However, we work with both you and your insurance carrier to determine how to provide you with the highest quality of care at the lowest possible cost. That is what makes us Bespoke.
Do you accept international insurances or workers comp?
Yes, Bespoke Surgical accepts a wide variety of international insurances, as well as workers compensation. Please contact us directly to verify your international plan. If you have workers compensation, please have all necessary paperwork filed and available prior to contacting us for an appointment. From there, we can easily work with your case management team to provide you the quality care that you need.
Do you accept clients from out of state or outside of the country?
Absolutely. The process is easy — simply tap or click “Become a Client” at the top of our website. Within the “Get Verified” form, there is a section “HOW CAN WE HELP YOU?” In this field, please indicate that you are traveling (and from where) and once we receive your registration, someone from our team will contact you to schedule a Skype session or phone call to discuss your needs and to make sure everyone is on the same page. We understand there is a financial investment in traveling, so this preliminary call allows Dr. Goldstein to properly evaluate your situation and provide an initial diagnosis, which will determine whether or not it makes sense to travel to be seen in one of our offices.
Can I get a consultation and treatment/surgery done in the same visit?
Yes, you can. Most clients who are traveling to NYC will schedule their consultation on a Thursday, receive treatment/surgery on Friday, and then have a follow-up appointment on Monday before they travel back home. If you are planning to visit our LA office, clients will schedule their consultation on a Tuesday, receive treatment/surgery on Wednesday, and then travel back home on Thursday. Depending on the procedure, you may have the option to fly home the same day as the procedure; however, most clients choose to stay for 1-3 days after. Regardless, we are more than happy to work with you to arrange times that suit your travel schedule.
Will I need someone to travel with me to the procedure?
If you are receiving anesthesia, you will need someone to check you out and bring you back to your hotel after your procedure. If someone is unable to come with you, we can suggest medical escort companies that we regularly work with to assist in getting you from the surgery center to your hotel at a reasonable cost (on average: under $100).
How will I receive my medication?
We will ensure that your medication is ready for you at the surgery center when you arrive. We use Capsule Pharmacy in NYC because they can deliver medication within a few hours at no additional cost to you (other than your regular co-pay). In LA, we work with ABC Pharmacy in Beverly Hills, which is conveniently located in the same building as our surgery center and will deliver upstairs.
Where do you recommend staying that’s convenient to the surgery center?
Our NYC surgery center is located in Midtown East, on East 47th Street and 2nd Avenue. We suggest flying into LGA, JFK, or Newark airport. While there are many hotel options, our recommendations are:
Our LA surgery center is located in Beverly Hills, on Wilshire and Doheny. We suggest flying into either LAX or Burbank airport. Our suggestions for conveniently located hotels are:
What happens if I still have questions?
Please do not hesitate to reach out directly: firstname.lastname@example.org.
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