Joy And Disappointment

[Soon2bFree 0]

So, my surgery was approved, and I was scheduled to have my procedure on the 9th of April 2012. Well, yesterday I received a phone call stating that I'll have to bring $4500 in order to receive services. I was completely devastated. I literally cried myself to sleep. Throughout this entire process, the fact that I'd have to come out of pocket for anything but my remaining deductible ($1500) was never mentioned. I have United Healthcare, Choice Plus, and they've implemented a Bariatric Resource Service program that covers expenses associated with the surgery, yet I still have to come out of my pocket $3000 and it doesn't make sense why. I've tried calling for additional information, but my case manager and the representative at the surgeon's office didn't provide me with much insight. Is anyone else familiar with this plan, and how it operates? I felt so defeated yesterday, I was going to give up, but I can't, too much is riding on this surgery.

Thanks for reading,

Sandi

[BigCraig 87]

Don't give up, UHC is horrible to deal with. It took me a year to get mine done.

If you are all cleared to surgery have your Dr office get in touch with the hospital CFO and make payment arrangements.

[Soon2bFree 0]

Thanks Craig, I called the doctor's office, and my contact implied that I need to pay up. I'll reach out to the hospital and try to come up with a payment arrangement.

[Lissa 2,631]

I wonder about people at some doctor's offices, not just WLS surgeons. I've had a constant round of doctor's visits since Feb of last year because of the medical problems that led me to having the sleeve. At one point, I had 8-10 doctor's appointments a week...and I kept up with my co-pays on all those appointments. I met my insurance deductibles and out of pocket requirements (except for co-pays, of course) by mid-June of last year.

One doctor's office in particular kept coding my visits wrong and the insurance company kept refusing to pay their part of the visit. My account at that office said I owed over $1700. The billing person in that office called me day and night for several weeks and even told me that the doctor wouldn't see me again until I "quit being a dead beat and paid (my) bill". I called my insurance company in tears and the woman there was a huge help. She even told me what code should have been used. I didn't call that billing person back; instead I spoke directly to the doctor about the issue. Suddenly my account balance was zero again...and that billing clerk now hides in the back office when I see the doctor. The scary part of it is that this is the pulmonologist who manages my asthma and my coumadin levels, so it's not like I can just quit going to him.

The point is, if you're still reading, that some doctor's offices don't seem to care if they are doing the billing correctly or getting you the maximum benefits from your insurance company. The insurance person gets something wrong and instead of billing it correctly, just assumes that the patient will pay that portion. I do understand that the bill is ultimately the patient's responsibility, but our health care system does not empower patients to easily interpret the insurance rules covering medical care. So it is difficult, if not impossible, for the patient to catch billing errors on the medical provider's part. I check all of my Explanation of Benefits forms and compare them to the bills I receive from my doctors' offices, but it's still very confusing. It's twice as hard when you are very sick and dealing with a lot of doctors at once.

[Soon2bFree 0]

Thank you soooo much Lissa! I'm so sorry to ear that you had to go through that. I've been up since 5am reviewing my benefits, and writing down questions to ask the hospital, doctor's office & insurance company. Hopefully I'll have everything sorted out by the end of the day.

[gmanbat 5,889]

Sloppy coding is a big problem.Wife and I had 3 operations, her rouxny, my gall bladder removal, and my sleeve. In all 3 cases the anesthesiologist used the wrong codes and we were stuck with the bill until we could talk the hospital into fixing the mistake or the insurance company into paying it anyway. In all 3 cases the hospital just sat on their butt and we had to keep calling the insurance company until we got a sensible person who realized that if they OK'd the operation they would certainly OK the anesthesia and just sent the check.

[cookies 56]

Are you on a plan that pays 80/20? If so, it's possible they're making you come up with the 20% you'll owe after insurance pays before you have the surgery.

I think if that's the case you should have been informed right from the get-go so you had time to get the money together, but I don't know.

I'm self-pay and I know they won't even schedule my surgery date without the money in hand. Greedy folks!

[Ms skinniness 3,003]

This is enough to break your heart! I know that coming up with an additional $3000 is doable for some folks, but it seems unethical in so many ways. I am so happy your still going to go through with the surgery, it is life changing! Can't wait for you to join us on the BIG LOSER'S BENCH!

[favoredone 590]

WOW.. I pray things work out for you!

[vivienvixon 1]

Where are u located? I thought UHC was one of the easiest to deal with. You are scaring me as well !

[Misstxdiva 73]

I have UHC Choice Plus as well. I have to pay $2878 out of pocket. I haven't met my deductible. I was so devestated. I called my surgeons office and surgery facility to work out a payment plan. I was determined to have this surgery come hell or high Water. Luckily I was able to work out a payment plan as an exception for the doctors fees. $1300 down at the doctor office and surgery facility $100 down. So thankful they worked with me., I would ask and pleA your case to the office. People are more open when you can put something down. Good luck and hope to see you on the losers bench next month.

[beautifulnewme2012 164]

I haven't crossed this bridge yet but I am told my hospital will require something down and make arrangements on the rest. If that isn't the case, I won't be able to have the surgery very soon either. I really hope you find a way to make it happen!!

[HopeThruFaith 30]

It sounds like you still have your out of pocket that has not been met yet. Once you've met your deductible you will be covered at your benefit amount until you've met your out of pocket. I have Cigna and my deductible was $1950 but my out of pocket was $3300. I met my deductble but I had to pay my surgeon $1083 to satisfy the remaining out of pocket. I hope it works out for you. Do you have a 401k plan you can take it out of?