Doctor's Office Lied

[starr 0]

Has anyone experienced your doctor's office lying about pre-surgical requirements?

I began the process by first calling my insurance provider and asking what was required for surgery. I was told only a letter from the doctor stating the surgery was necessary. I then scheduled an appointment with the doctor. During the call I gave the girl who handled insurance at the office my info from my card. I was then given a date to meet with her and the doctor. When I finally went to the doctor I was told that my insurance REQUIRED me to have 5-6 things done including sleep study, blood work, dietician visits for 6 months, etc. I was told the person I spoke to gave me incorrect information.

I met with the doctor and he was very nice. After the visit I went home confused and frustrated. I call my insurance again and once again was told of no pre-surgical testing. I really didn't have a problem with having test done as long as it was for the better but I was told it would be 9-12 months before surgery.

The doctors office called and scheduled my dietician appointments and blood work.

After about three months I had never heard my results from blood work. My calls were not returned trying to schedule my sleep study etc. I GAVE UP!

Yesterday I scheduled an appointment with another office that offered LabBand. This morning I met with Liz the insurance specialist at the office. She actually called the provider line and put them on speaker phone with me in the room. She asked "What pre-surgical testing was required?" Guess what - Other then a letter from the doctor - NOTHING WAS REQUIRED. No dietician appointment for 6 months, no sleep study, NOTHING.

She looked at me and was confused because I had THOUSANDS of dollars of testing and visits that were not required. I was told my 8 months to surgery was more like 8 weeks now. I feel like I was totally lied to and taken advantage of. I know of another person at my company who was also having LapBand done was told by the same office that all these test were required by our insurance. Money making scheme? Insurance rip-off?

Just wanted to know if anyone else has experienced this?

I learned several things - call insurance, I even called the provider line. Call several times and talk to different people. Take the names of the people you have talked to. If you have the ability check with other doctors in you area and speak with their insurance specialist. They are more then willing to talk. It's YOUR money and YOUR insurance.

Edited September 5, 2008 by starr

[gilliebean 1]

Well here is the thing. Most doctors require this stuff rather the insurance does or not. So they know your safe to perform the surgery on. And most insurances do require the tests. And will tell you they don't approve the surgery and say its because you don't have those things. So the doctors office probably ment well. I wouldn't stress about it just go on where you are now and let it go its not worth it.

[nita 0]

Has anyone experienced your doctor's office lying about pre-surgical requirements?

I began the process by first calling my insurance provider and asking what was required for surgery. I was told only a letter from the doctor stating the surgery was necessary. I then scheduled an appointment with the doctor. During the call I gave the girl who handled insurance at the office my info from my card. I was then given a date to meet with her and the doctor. When I finally went to the doctor I was told that my insurance REQUIRED me to have 5-6 things done including sleep study, blood work, dietician visits for 6 months, etc. I was told the person I spoke to gave me incorrect information.

I met with the doctor and he was very nice. After the visit I went home confused and frustrated. I call my insurance again and once again was told of no pre-surgical testing. I really didn't have a problem with having test done as long as it was for the better but I was told it would be 9-12 months before surgery.

The doctors office called and scheduled my dietician appointments and blood work.

After about three months I had never heard my results from blood work. My calls were not returned trying to schedule my sleep study etc. I GAVE UP!

Yesterday I scheduled an appointment with another office that offered LabBand. This morning I met with Liz the insurance specialist at the office. She actually called the provider line and put them on speaker phone with me in the room. She asked "What pre-surgical testing was required?" Guess what - Other then a letter from the doctor - NOTHING WAS REQUIRED. No dietician appointment for 6 months, no sleep study, NOTHING.

She looked at me and was confused because I had THOUSANDS of dollars of testing and visits that were not required. I was told my 8 months to surgery was more like 8 weeks now. I feel like I was totally lied to and taken advantage of. I know of another person at my company who was also having LapBand done was told by the same office that all these test were required by our insurance. Money making scheme? Insurance rip-off?

Just wanted to know if anyone else has experienced this?

I learned several things - call insurance, I even called the provider line. Call several times and talk to different people. Take the names of the people you have talked to. If you have the ability check with other doctors in you area and speak with their insurance specialist. They are more then willing to talk. It's YOUR money and YOUR insurance.

My Lapband doctor's office required me to have a mental evaluation and a letter of necessity from my doctor which I did. I also had previous records on different diets that I had tried and failed at. That was all I was told I needed but when my doctors's office submitted my request to the insurance company they said I had to go through another six month diet with my family doctor keeping records. I am on my third month and hoping after this I will be approved by my insurance company. I started this process in March.

[starr 0]

I think the biggest problem for me was the fact that they lied to me. I lost faith and no longer trusted them. If they would have just said something like "While your insurance doesn't require these test we think it is important for your health and safety." I guess I am just a little stressed out over all of this and having to start over with another doctor.

Edited September 6, 2008 by starr

[Mamacj 0]

I have had similar testing pre op, all these things can help determine your suitability for surgery. I know it seems like just another way to spend your insurance money, but I can't imagine any surgeon taking the risk, to you or to his practice, by not doing preop testing. I'm not saying they were right, it should have been better explained to you why the tests were being done and it really shouldn't take more than 2 months to get all these things done. I will say that the insurance company may say they work for you, but their goal is to keep collecting premiums and to not spend money. I don't know the whole situation, but I would be suspicious of any doctor who didn't at least want some blood work, a chest x-ray and an EKG. Do what is best for you and your loved ones.

Best wishes in your journey, CJ

[brown bear 0]

Sounds like a money making scheme to me and I'd be mad, too. They should have been honest up front. If your insurance does not require it then they do not require it. Lots of good doctors require only a few tests to determine surgery suitability and those tests can be done quickly. Thank goodness you are working with an honest doctor now as you will have a long relationship. Good for you.

[bbjerseygirl 0]

Every insurance company is different but most doctors are using Aetna standards and don't look at all insurance information. When I went to my doctors office I was going to follow the standard 6 month pre op routine, but the testing was not insurance required - but doctor required. Since I had no medical problems really other than the obesity - I had minimal testing except right before surgery. I had asked since this doctor had a program fee that they try to pre approved me early so I didnt' pay out all this money and not be approved. They were extremely surprised to find out after only 6 weeks in the program, that I had no pre op requirements so I was approved right away. Most insurance companies don't require testing . They require you meet a certain criteria such as 40 BMI and that you had tried losing the weight prior to surgery intervention. I believe in your case, the doctor was blaming the insurance company for all these tests that he wanted done. If he requires the tests for surgery, that's what he should tell his patients. Many people on here had to do numerous tests before being considered without any apparent health problems, and they probably weren't necessary or insurance required. I am glad you found a doc who could do the surgery without more tests. The good thing is that you know you are in good shape with all the testing to proceed with surgery. Good luck