Boiling Inside! Incompetence runneth over! Beware!

[KeeWee 470]

I can totally relate to your frustration with the situation. When I was going through the pre-op process I hit a road block that was to this day one I am not sure I did the right thing about. I had seen my PCP to get the referral to a contracted surgeon (the usual step one). I called the surgeons office and was told I had to go to a seminar before they would set the intake appointment. The seminars were held once a month so I scheduled for the next open date (which was 2 months from the phone call). After the seminar I made the intake appointment (another month wait). The labs, consults and testing took another 3 months to complete. When I had my surgery date, 9 months had gone by and I figured, not too bad of a wait to get the surgery. Then I went to the surgeons office for the pre-op "physical" and was told my insurance wasn't covering the procedure at 80 % but only 65% and they required my portion be paid before they would confirm the surgery date. I made several calls to my insurance and the long & short of the phone tag was that the surgeons office did not complete some paperwork on their end and lost the preferred provider status. I was told I could "restart the process" with a new surgeon or continue with the current provider but have to pay the non-contracted provider rate.

I wanted the surgery to be done and over with so I paid the non-contracted provider rate. Just before the surgery, the surgeon requested to be allowed to perform a new procedure called the spider technique and he would take out my gallbladder while he was doing the sleeve (I had gallstones and knew the weight loss would most likely cause a flair up) After hearing about the spider technique (one incision) and that he would remove the gallbladder through the same incision I agreed to let him do the procedure (I was to be his first "live" patient for this technique and the first he did 2 surgeries in one per the doc). Now the one thing I didn't think about was the fact that he was now a non-contracted provider. Also I did not get a prior auth for the gallbladder surgery. SOOOO...... After the surgery I got the bill for his services (and his assistant) My insurance didn't cover the gallbladder procedure and I was stuck with an extra 7000.00 expense. I am still fighting with his office about the non-contacted status and that I should not have to pay this bill since they didn't fill out a form and they didn't get the prior auth with the insurance before the surgery (how was I supposed to know all the medical billing stuff) I thought he made a deal to take out the gall bladder if I let him perform the surgery with this new technique. Guess I was wrong.

Im surprised anyone is arguing this with you. I am a Utilization Review Manager and Certified Medical Insurance Specialist and I can tell you now that if you did not get an authorization or you did not fill out any paperwork for that procedure, you CANNOT be billed for that. In private offices, they do things unconventionally and if you don't seek a lawyer or some type of professional, they will try to make you believe you have to pay because you don't know any better. Please seek counsel, this case is legally considered abuse, not fraud and if you don't know the difference "legally" you have no chance. YOU DO NOT HAVE TO PAY!! Ok...free advice for the day..lol, have a good day!!

[KeeWee 470]

Keep your head in the game. Appease her every whim and whilst doing so, document EVERYTHING she has or hasn't done, has or hasn't said and the times and dates she did or didn't do them. The full nine yards.

As soon as you get what you need, you write a deposition to the complaints department. In fact, I would go so far as to assert that if there are more people less 'together' than you, charged to be under her care, that you personally fear for their safety as she's clearly not fit for purpose (I would mention that she appears high) and grossly unprofessional.

You had me at 'shoulda paid your phone bill'. I'dve hit the freakin' roof at that.

But as has been stated. Hold your counsel until such time as you can let rip.

My sympathies are with you.

Thanks so much, this is exactly what I plan to do! I'm trying to just hold my tongue until the timing permits. Now I'm just sitting waiting for my denial but i hope some prayers went up for an approval!! Thanks again..