Advice Needed

medussa · June 9, 2006

I was banded may 18th. Despite having BCBS insurance, I was self pay mainly because I was told I had to have 1yr of documented weight loss efforts via my MD. I wasn't going to wait another year so I just paid up front. I was lucky because all my pre-op stuff was submitted to my insurance and was paid for. It amounted to about 5,000 dollars when all was said and done.

Before surgery, I was required to pay in advance for the surgery, anesthesia, and the hospital stay. That all amounted to about 8500$. Today I got some insurance papers in the mail and it appears that the anesthesia group submitted a bill to my insurance company (despite being paid in advance) and the insurance paid the bill. The radiologist that did my barium swallow study also submitted a bill and was paid. The insurance paid out about 2000$ between the two. They were double paid. I am pissed because I want my money back. Not to mention that the insurance company was charged less than me. Who do I go to to get my money back?

sleepyjean · June 9, 2006

Here's what I'd do: start with your doctor's office. Call and ask to speak to whoever is in charge of billing and whoever is in charge of insurance. Tell them both what happened and say you're hoping to work this out without having to go to your HMO. Be very pleasant and let them know you want to be reimbursed and ask if you are speaking to the appropriate person to take care of that.

That's about all you can do. If you're lucky, they'll send you a check. If they refuse, then you need to get BCBS involved. Unfortunately, they will be focused on getting THEIR money back, so you're unlikely to see any of your money again. But at least the Dr. wouldn't be paid twice. The Dr's office, if given a choice, will refund the insurance company - not you. It's just a better business decision for them to refund the lesser amount and besides, they have more to lose by fighting with them then fighting you.

fabfatgrl · June 9, 2006

Sometimes with self-pays they give you bargain rates... and the understanding is that if they can get more from your insurance company, that's a bonus for them. $8500 is pretty cheap... consider yourself lucky.