Insurance Fraud??????????????/

[JMO 0]

Ok I have a delema. My Dr., who is IN network has told me he charges a 500.00 participation fee that can NOT be billed to ins. So I called the ins. company to see if it can be counted as my deductable, They said no because he is under contract with them and he should not be billing a pacient any more than the copay they agreed on. Then my ins. company said he could lose his contract with UHC if he is reported. So my delema is, This Dr. is known for his experence (over 3000 lab bands done) and for his crappy bed side mannor. I am afraid if I question his policy and ruffle feathers then he won't do my surgery. (lord knows he has plenty of other people who want him) So should I pay it and just shut up or should I fight it and take the chance in having to find another dr. and start all over... I had planned on paying this money but now I'm justed pissed that he is taking advantage and doing something that is not ethacal... :angry

[Marlluvia 1]

I'm not sure what to suggest on this one. I would be very upset if I were in the same situation. It seems like alot of doctors are really becoming greedy and taking advantage of people who are in true need of their services. If you can find a doctor in your area that takes your insurance, I think I would check into it and find out how hard it would be to change doctors. Experience is a major plus, but so is ethics. In the end, it's a decision you'll have to make. It's not fair that you should have to pay a fee when your doctor is supposed to be contracted with the ins. company. I hope you get it everything in order for your surgery. Best of luck.

Gracie

[Anwyn 0]

Does that $500 go towards nutrition counseling or support groups or something similar? The amount contracted with UHC is for the actual procedure. He can't charge you that extra $500 for the procedure, but he can set up requirements under the guise of properly preparing you for the behavioral changes needed after surgery. From what I've seen on here, it's not an unusual practice.

[Alexandra 55]

I don't see anything really wrong with this either. Anne makes a good point: your doctor is a surgeon, not normally in the business of providing nutritional counseling or other support services. Yet these things are important for banding success, so he wants you to have them and you should want to have them too.

If he doesn't offer any of these services, you should find another doctor. Because regardless of the cost, these are very important factors in your success as a banded patient.

[SusanP 0]

If you are talking about Dr. Speigel...find a new doctor. I have an idea that he's in trouble with UHC for fraud. I have been called by UHC 3 times in the past month about him and the documents they are sending me are outrageous. Yes, I am afraid of leaving him because of his expertise, but there is something definetely going on with him and UHC. I have only had wonderful experiences with his bedside manner, but I need an in network doctor who doesn't conflict going on with major hospitals or insurance companies. Just my experience with the situation and it's unfortunate because I enjoy his staff and one of his staff members saved my life last week when I was vomiting lots of blood. They didn't charge me for the visit. After experiencing such as scary situation, I decided that I needed a doctor, in network, to treat me. It wasn't fun puking blood and trying to figure out how to get help. Hope this might help, Susan

[barbara465 2]

Having just gone through the stress of having a doctor (spiegel) and being accepted, to him going out of network and wanting to charge a large, large, fee, finding another doctor, trying to get approval from UHC for new doctor, and the last minute going back to spiegel at a reasonable price I say pay the $500 and call it a stress reducer!!!!!!!!!!!!!

I can't begin to explain the emotional roller coater I have been on with what was supposed to be such a easy process to change doctors. However, if you have time, and you feel strongly about it, then by all means change. No one should wonder about their doctor.

[Dody 0]

Ok I have a delema. My Dr., who is IN network has told me he charges a 500.00 participation fee that can NOT be billed to ins. So I called the ins. company to see if it can be counted as my deductable, They said no because he is under contract with them and he should not be billing a pacient any more than the copay they agreed on. Then my ins. company said he could lose his contract with UHC if he is reported. So my delema is, This Dr. is known for his experence (over 3000 lab bands done) and for his crappy bed side mannor. I am afraid if I question his policy and ruffle feathers then he won't do my surgery. (lord knows he has plenty of other people who want him) So should I pay it and just shut up or should I fight it and take the chance in having to find another dr. and start all over... I had planned on paying this money but now I'm justed pissed that he is taking advantage and doing something that is not ethacal... :angry

I went with a friend of mine a couple years ago to Salt Lake City as she was going to have RNY done there. The dr. there is a well known dr. famous for doing RNY. The secreatry told her that before the surgery $500.00 was due (the reason for this she said was for the following years information and support groups). My friend informed her she was 6 hrs. from Salt Lake and would be attending a support group in Idaho (which cost nothing by the way). They still insisted on collecting the $500.00, which got her absolutely nothing, but they would not do the surgery without it. She had Tri-Care and they picked up the surgery. To this day she is furious she had to pay $500.00 out of pocket that had nothing to do at all with the surgery. It seemed like kind of a scam to me, but she didn't want to ruffle feathers either and just paid it.

Sorry you are going through this, but I guess it really isn't that uncommon in some dr's. practices. You could seek a new dr. perhaps. To me this was just some extra bucks in the doc's pocket for something of no use to my friend.

Good Luck,

Dody

[FunnyDuddies 6]

It is not unusual to charge a "participation fee" to weight loss surgeons/clinics. While I do not agree with them, they do have ways of billing it so that it does not fall under other things your ins should cover. They are billed to you as being for support groups, gym memberships, nutritional counseling, etc. You might not get any of these things, but they can go to the ins company and tell them that is what it is for to keep their contract.

This aside, if your doctor is Dr. Spiegel, I would heavily weigh your feelings on this situation. He is not my doc, I have never met the man, and I never will. But I have read post after post of some serious issues people are having with him. He may be a great surgeon, but the follow up care and the life of your band is important, and you will need coverage for it. UHC seems to be having a falling out with him, and you don't want to be stuck without coverage when you find you really need it!!

[gviscio 0]

The fee is not unusual. Many offices charge this fee as an administrative fee for paperwork, nutrition counseling etc. Also just in case your insurance company doesn't pay him for his consultation.

That other doc you spoke of, beware of docs who in the past could not get the band covered so they billed this as a bypass. That is a problem on the Surgeon's part and could come back to haunt you. Such as when you go to get a fill or have a complication and now the carrier thinks you were part of the fraud.

If the money is an issue ask them to please waive it. THey'll be making more than that once your done and happy.

[Angels 0]

I say pay the $500 dollars at least you don't have to pay the $14,000. At least that is the way I looked at it. My doc $500 fee is for hajving access to a personal trainer for 8 sessions, a nutrionist, a therapist, if needed. I paid that with much happiness since I was approved by UHC. Don't start over it just takes too long and why put yourself through unncessary stress. GOODLUCK!

[pplqueen 0]

Pay the money, have the surgery. Then call and report him.... Just because he is skilled does not mean that he should be able to get away with Fraud. He is just making fat people pay extra so he can drive a better car. Doctors sometimes suck! I am a nurse. believe me. Good luck!

[Elisabethsew 50]

You can report an MD to the insurance company anonymously. Do that and pay the $500. If he's under investigation and proven at fault, he will have to make restitution to the patients he scammed.

[DonnaB 3]

You can report an MD to the insurance company anonymously. Do that and pay the $500. If he's under investigation and proven at fault, he will have to make restitution to the patients he scammed.

Yeah. Hold your breath and wait for THAT to happen.

[JMO 0]

Pay the money, have the surgery. Then call and report him.... Just because he is skilled does not mean that he should be able to get away with Fraud. He is just making fat people pay extra so he can drive a better car. Doctors sometimes suck! I am a nurse. believe me. Good luck!

My husband and I have talked, and we are staying with this dr. He is the most experenced in this area, and seeing that we are both having it done, and my hubby has never had surgery and a big chicken, he wants the best. I still disagree with the fee. I was told it was for paperwork???????? I was like hu? Then she said filing the ins.. and nutrition, and three months of fills. 1st off I can file my own ins. papers, 2nd a nutritionalist is only 75.00 a pop here and I get a discount from my ins for them, 3rd three months of fills? My fills are only 15.00 copays, I highly doubt I am going to need 500.00 of the in the first three months after my surgery.

My husband work in ins. for 5 years at atena so he knew this was crap. And the fact they did not say a word about this fee in the seminar still greats my nerves. I was not told about this fee till I had done all the requirments and was approved. They know exactly what they are doing they are banking on me not changing Dr. And I am not. I have fallen in love with the office and the staff. I even like the dr even though he is known for his bedside mannor. I want this surgery more than I want 500.00 I need to be thanking my lucky stars I have ins. that approved me. I am only out of pocket 1150.00 for everything!!!