Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Really Upset..insurance Covering 85% Of Lap Band But I Have To Pay 15%



Recommended Posts

I dont want to be the bearer of bad new but maybe since I had to self pay I am bitter...LOL! Seriously for the doc to take what insurance pays and waive the rest is fraud so I wouldnt talk about it here especially if you have links or references to who your doc is! It is illegal for a doc to charge a different amount for different patients so shhhhh!

Share this post


Link to post
Share on other sites

Why would that be fraud? The doctor is the one that is losing money, he gets the same from insurance regardless of if he waives the 15% fee or not. It would be fraud if the doctor or the patient lied to the insurance company in order to get the surgery paid.

Plus the doctor isn't charging the patient a different amount, he is just deciding whether on not he chooses to collect on what he is owed.

Share this post


Link to post
Share on other sites

Have you already been approved by your insurance company for the procedure? It is not an overnight process.. I have been working on mine since April. It was finally submitted to the insurance company on Wednesday, Nov 31. I called today and they still have not put it into the system yet.. I would really shop and make them earn your business.It is not fraud, but standard medical practice to waive fees expecially for those who have insurance but the provider is out of network...

Share this post


Link to post
Share on other sites

Xavier its not fraud. My insurance told me they don't care if I pay the remainder 20% or the deductible that between the patient and the doctor. He charges the same but he basically takes the 80% that the insurance does pay. Basicaly he is just giving us a discount.

I dont want to be the bearer of bad new but maybe since I had to self pay I am bitter...LOL! Seriously for the doc to take what insurance pays and waive the rest is fraud so I wouldnt talk about it here especially if you have links or references to who your doc is! It is illegal for a doc to charge a different amount for different patients so shhhhh!

Share this post


Link to post
Share on other sites

My surgery is next Thursday and I actually received a call from the hospital today. I owe 10% and was told by the hospital that if I could pay the entire 10%upfront then I would get a 25% discount off the amount. But, I can't, so I am just giving them $50.00 on the day of registration and waiting for the final bill.

Share this post


Link to post
Share on other sites

It is not fraud to "write-off" the difference between what he charged and what the insurance paid. I've worked in the medical field for 27 years as an office manager in a private practice and we do it all the time.

Share this post


Link to post
Share on other sites

It is very commonly done but it is fraud. A physician cannot under any circumstances charge one patient a different amount than another for the same procedure for any reason.

Share this post


Link to post
Share on other sites

Doctors charge self pay patients different prices than insurance covered patients.

Example: The location I am getting my procedure done at charges $17k for self pay, but upwards of $25-30k for insured patients. So, I'm guessing that the price difference for this particular doctor is like a self pay vs. insured patient. Obviously the people with insurance that covers the procedure will still pay less, but the doctor's take a cut in price for self pay since most people probably can't pull 25-30k out of their finances or finance the balance. I'd love to be charged the self pay price and only pay 20%...

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • cryoder22

      Day 1 of pre-op liquid diet (3 weeks) and I'm having a hard time already. I feel hungry and just want to eat. I got the protein and supplements recommend by my program and having a hard time getting 1 down. My doctor / nutritionist has me on the following:
      1 protein shake (bariatric advantage chocolate) with 8 oz of fat free milk 1 snack = 1 unjury protein shake (root beer) 1 protein shake (bariatric advantage orange cream) 1 snack = 1 unjury protein bar 1 protein shake (bariatric advantace orange cream or chocolate) 1 snack = 1 unjury protein soup (chicken) 3 servings of sugar free jello and popsicles throughout the day. 64 oz of water (I have flavor packets). Hot tea and coffee with splenda has been approved as well. Does anyone recommend anything for the next 3 weeks?
      · 1 reply
      1. NickelChip

        All I can tell you is that for me, it got easier after the first week. The hunger pains got less intense and I kind of got used to it and gave up torturing myself by thinking about food. But if you can, get anything tempting out of the house and avoid being around people who are eating. I sent my kids to my parents' house for two weeks so I wouldn't have to prepare meals I couldn't eat. After surgery, the hunger was totally gone.

    • buildabetteranna

      I have my final approval from my insurance, only thing holding up things is one last x-ray needed, which I have scheduled for the fourth of next month, which is my birthday.

      · 0 replies
      1. This update has no replies.
    • BetterLeah

      Woohoo! I have 7 more days till surgery, So far I am already down a total of 20lbs since I started this journey. 
      · 1 reply
      1. NeonRaven8919

        Well done! I'm 9 days away from surgery! Keep us updated!

    • Ladiva04

      Hello,
      I had my surgery on the 25th of June of this year. Starting off at 117 kilos.😒
      · 1 reply
      1. NeonRaven8919

        Congrats on the surgery!

    • Sandra Austin Tx

      I’m 6 days post op as of today. I had the gastric bypass 
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×