Consultation Fee?

Margo · May 2, 2005

Hi...

Just wondering if your doctor had you pay a consultation fee? Actually, my letter from the doctor called it a "Program fee". If so, what was the fee and was it non-refundable? One more question, sorry...did you send in the fee charge to your insurance for coverage?

Thanks.....love this board....I have learned so very much from everyone....

Margo

CollegeJoe · May 2, 2005

yeh i was also wondering that too....im going in for a seminar may 17th so like when do i get billed for a consulatation fee?

Alexandra · May 2, 2005

Every doctors' practice is different, but to my mind there should be no charge for seminars. They are essentially marketing tools for the doctors' offices, which serves them more than they serve you by letting them do the intro for dozens or scores of patients at one time. If there is a fee it should be nominal, like $10 or so, to cover the cost of copying the paperwork. It's not anything that can be submitted to your insurance carrier, because it's just a meeting not a medical visit.

A consultation fee should be charged if you have had an office visit with a surgeon who spent one-on-one time with you. This is payable whether you decide to have surgery or not, since it was a doctor's visit. It's a medical evaluation so it's certainly fair game to submit to insurance. If you're using an in-network surgeon there might only be a copay for this visit.

Program fees, to my mind, should only kick in once you've decided to have surgery and become a patient of the practice. The one fee (if there is one, not all surgeons' offices do it this way) might include a couple of follow-up visits to the surgeon, possible a nutritionist as well, support group meetings, and maybe a fill or two. (It doesn't make sense to me to pay up front for fills, because no one can predict how many a given patient will need, but it looks as though many docs are throwing them in with the surgical charge.)

Look at what the "program" fee includes to decide whether you can submit it to your insurance carrier. Office visits or meetings with medical providers are medical expenses, support-group meetings are not. So if you're being charged one amount for all of that, see if they will break it down for you for insurance purposes.

paula · May 2, 2005

My consultation fee was submitted to my ins. comp and I only had to pay my co-pay of $15 when I went for this visit.

Margo · May 2, 2005

Thanks for all the great information....

Simply put the letter says that "a program fee of $300.00 must be paid prior to submitting paperwork to your insurance cover"

Any comments?

Margo

the best me · May 2, 2005

I'm thinking they are charging you to this to weed out folks who aren't serious. They are only taking up office anc Dr time for those who are more likely to go through with it. If you don't want to cough up the 300, you aren't ready. See what I mean?

Then, once the insurance is filed and starts paying, the 300 comes out of the bill somehow, either to cover your co-pays or a psychologist visit or whatever...kind of like a credit on your bill. Heck, they may even refund it? When I first started looking into it, my local doc did the same thing, but since I found out my insurance excluded the Lap Band, I went no further with him and self-payed in MX. so I never coughed up the 300+ he was going to charge for the initial visit.

Pretty sure it's a weed-out feature. It probably all comes out in the wash and you won't be over-paying. If you are sure your insurance covers the Band procedure, I'd go for it. Beats the 9K I had to pay, and you stay local! Don't get me wrong, I love my Band doc and regret nothing, but it would have been nice to stay local and have ins pay....

Alexandra · May 2, 2005

Margo, if you're at the point with this doctor that they're going to submit your medical records to the insurance carrier, then you're already a patient. A lot of time and effort has gone/is going into getting your file ready for submission, and it's well worth the $300 if you believe your carrier will cover the surgery. What is your sense about that? If you have an exclusion or have other reason to believe you won't qualify, then you might want to think twice about paying the $300. But if you are on your way to being operated on by this doctor and you/they think you'll be approved, it's a reasonable fee worth paying.

Good luck!!

paula · May 2, 2005

hmmmm...

*this was my experience* when I called my surgeons office to schedule my initial consulation, they got my insurance info and called to verify my coverage.

They (surgeons office) called me back and told me what my co-pay would be for this visit, what I needed to do to gain approval, AND approximately what my entire portion of the sugery's fee's would be. (I also called my insurance comp later and compared what the surgeons office told me to what they (ins. comp) told me.)

Hope this helps.

Margo · May 2, 2005

I called for an appointment (my first), they took my insurance information, they sent me a packet with a long list of questions, etc., and a cover letter that says "There is a program fee of $300.00 which is non-refundable. This payment must be make prior to our submitting any paperwork to your insurance company."

That is it in a nutshell....

Margo