Insurance said yes, then no after the procedure.

[FrustratedInLA 0]

I'm new to this forum, so please bare with me! I've had my realize band surgery on September 16 and the surgery went great. I was in and out of the surgery center in less than 3 hours. My doctor was great before hand and for the surgery. But my troubles started after the surgery. During my initial conversation with my Dr, I expressed concerns with regards to the cost. I was told that they will go through the process of verifying my insurance. I received an approval letter within a week. During my discussion with my dr, they assured me that my out of pocket expense should be approx. $4000 but it might go up to as high as $8000. I was okay with that. After the surgery, I never heard a word from my doctor. Not even a follow-up the day after. I had to call them to schedule my first fill - which was supposed to have taken place last week. In the mean time, I received the bills for the surgery and came to find out that my insurance isn't paying for about 90% of it. My dr's fee alone was $14,900, but the unbeknownst to me, he added the new doctor at his practice to my surgery as well. I essentially hired one doctor and was given two, for an additional $4000. The insurance only paid $900 of that. Then the real shocker came. The surgery center , where I was for 3 hours, which includes before, during and after surgery, charged a whopping $76,000. And the insurance is covering none of it. And this surgery center is the same place where on the day of the surgery, my doctor had 8 patients lined up for surgery that day. Talk about a cattle call. But needless to say, his surgery coordinator assured me that this was the best location and that insurance will most certainly cover this particular location. I'm so angry with my Dr & his staff that I opted to cancel my fill appointment, out of fear that they will hit me with another astronomical bill. So, I guess my question is, what do you do if your insurance says yes before and then no after the procedure when it comes to claims. And also, how do you suggest I handle the situation with my doctors' office? I feel like they deceived me on purpose by not telling me exactly how much each service would have cost, especially since I asked so many times prior to the surgery. I'm so disappointed in the whole experience, I still have no fill and I'm on the fast track to being bankrupt with a $100K bill. Any advice and/or suggestions?!

[nkara 0]

My suggestion would be don't pay it and go talk to a lawyer. You were swindled!

[Humming Bird 275]

I agree with nkara. I hope you still have the approval letter and any other documentation about costs. All of it sounds very fishy to me.

I was self-pay and the entire thing, Dr., surgery, anesthes., everything, was a grand total of $9950.

[GraciesMom 0]

I am so sorry to hear this story happened to you, but I agree with the other posters, you have been swindled.

First thing I would do would be is talk to an attorney and see what he/she has to say about this situation.

Another suggestion is get in touch with your local TV station news, actually you can probably go online to the web site and see if they have a investigating reporter. I know in the Chicago area each of the local channels have one. I would blow the whistle LOUDLY on these rip-offs. I can promise you you are not alone either. The thing about the media, is others who have sat back quietly making these idiots rich, suddenly realize they have a voice as well and start standing up.

You know, for all of history, there are those who prey on those who are in need. When they see that there is a way to make money, they will because they know that in a weaken and fretful state, the victim usually will just go away.

Again, I am sooooo sorry.

Please talk to someone you trust, and then get some help with this, this is not right...do not let them victimize you anymore! Go get these scum.

[LuuLuu 62]

I agree with the others that this is a crock. However, I think you should start with your doctor's office. Give them the chance to fix it.

On much smaller scales...I have debated bills with individual offices and had them reduced or resubmitted to a favorable resolution.

If this does not work - stop talking to them and seek legal advice. But also seek legal / medical advice on moving forward with your weight loss journey. Don't compound the tragedy by wasting your surgery!

Edited October 26, 2009 by LuuLuu

[FrustratedInLA 0]

Hello Everyone. Thank you so much all your reply's! I feel so much better knowing that I'm not alone in dealing with issues like this! Since my last post, insurance changed their mind and they will now pay $31,000 for the $76,000 Surgery Center Bill. That still leaves me with over $40K. But I requested an itemized bill from them. If they charged me $5000 for a plastic tube, then I want that plastic tube! But I'm ready for a fight. I already told them that I will not pay that. I also told my doctor that. The insurance paid $900 for the assistant surgeons $4000 bill. So my doctors office told me that I won't have to pay for the balance. How about that. But I got my gloves out of the closest, I dusted them off and I'm taking them for a trial run! I'm done with other people dictating my life and having fears run my life. I have my first fill appointment today with another doctor that I found, so I'm actually excited and scared at the same time! But thank you for all the support - I wish I'd found this board prior to my surgery!

[sil 0]

good for you, go get em tiger. you dust those gloves off.i predict a knockout. and the winner is(frustratedInLa).

[nkara 0]

:thumbup: You go girl! Fight till your hearts content. Don't let the big companies take advantage of you.

This whole weight loss issue and surgery is an emotional enough process without having to go through this additional stress.

[Bjornsyouruncle 0]

Save your EOB's and see if you can schedule a time to sit down with the insurance coordinator and have them walk you through it. Conceivably your insurance policy should have an Out of Pocket Maximum, and any amount over that should be written off by the doctor's office.

Just because you are billed a certain amount does not mean that you will be responsible for it.

Good luck with getting everything sorted out.

[RiahRiah 0]

Save your EOB's and see if you can schedule a time to sit down with the insurance coordinator and have them walk you through it. Conceivably your insurance policy should have an Out of Pocket Maximum, and any amount over that should be written off by the doctor's office.

Just because you are billed a certain amount does not mean that you will be responsible for it.

Good luck with getting everything sorted out.

I agree with Bjornsyouruncle. I work in physician billing and I can tell you that sometimes it can be a mistake of payment by the insurance companies but also sometimes it can be the fault of the physicians office. When the insurance company makes paymens there are also contractual adjustments to the balance etc that are due. Even after talking with the dr's office again I would try and go over all of your EOB's with the insurance company to make sure everything is correct. Make sure to have an Itemized bill from the doctors office showing all of any adjustments, payments posted etc when going through this with the insurance company. If there are any discrepencies often times the insurance company can three-way call the dr's office so that you can get everything squared away together. Good Luck! After everything is ironed out ask about payments plans etc. Often times the dr's office will work without especially if you weren't expecting such a large bill. It can be a big pain but hopefully everything will work out the best for you in the end.

[AZSunshine 0]

Oh my goodness!!! What a total crock!! I am so sorry you're dealing with all this on TOP of trying to recover!!

Do you have a letter from your insurance stating that they approved the procedure? If so, they should cover it at whatever percentage your plan dictates.

Do you know if the physician/surgical center were "in-network"?

I'm absolutely shocked that your insurance didn't try to negotiate with the center.

My bill (for EVERYTHING) was $32k.... my insurance negotiated it down to $19k.

Many hospitals/med facilities overbill by astronomical amounts. They don't expect anyone to actually pay... but they get tax breaks for it because they can count it as a loss.

Call your insurance company and see if you can figure out what the hell is going on. If you can't budge, call the hospital and see if you can negotiate a lower rate. $76k for a short stay is appalling... I can't even wrap my head around it.

I'm so sorry you're dealing with this... if all else fails, I'd file a complaint against the physician.... and contact an attorney.

Good luck, please keep us posted!

[Cocoabean 430]

I am coming into this a bit late, but dang, what a crock!! How can an insurance company change their minds after the fact?!? And adding a second doctor while you are under? Wow. I am dumbfounded.

I am hoping everything is working out. I am glad to read you are not accepting being victimized like that.

In my case, I got a copy of the hospital bill. It was $43k. Wowser! But my copay was $100.00. I knew I didn't have to pay any of it, but would not have been surprised if they would have cashed a check had I mistakenly sent them one! I don't think they were even supposed to send me a copy of the bill. But they did.

Best wishes as you continue to fight!!

Denise

[msdv 5]

wow, I'm late in here but this situation is totally outrageous to me.

How in the world does a reputable hospital charge someone $76,000 for a 3 hour stay? WTH!!!

I'm afraid of this happening to me. My PCP referred me to a great well known Dr here in NY however after starting out with them I started hearing YES we accept your insurance but they are out of network when I spoke to the insurance coordinator she assured me that they would accept whatever my ins. paid , she estimated that to be about $1500. and they would write off the rest :tt1: that set off bells for me. Why would they do that? I'm not poor. I know how they get all these benefits and the rest but again why would they do that?

I decided to check out other Dr's that would accept my insurance . I have all the conditions to be fully approved for this surgery...BMI over 40 and 2 co morbidities . Why wouldn't my insurance cover me.

I was afraid like the OP that I would have the surgery finally be on my way to lasting weight loss and then stuck with bills out the wazoo that could very well bankrupt me & my DH.

This is going to be the next big rip-off preying on people that are desperate to lose weight .

I hope the Op comes back in to let us know how this was resolved at all.

[gingerjane 5]

I am still in the process and have been researching surgeries, the cost, etc., just in case I'm not covered. What they charged you is flat out price gouging. Unless they used a gold-colored tube, there is no way it should cost that.

What I would do is find out if they submitted a higher bill to the insurance company to see what they would pay and if there is a contract where the balance is not the patient's responsibility. I know that in some cases, per contracts, the doctor has to write off the balance.

Also, call around to find out what the self-pay cost is. Even have someone call their office to see what the self-pay cost is. The doctor that I chose has a self-pay of $12000. There is NO WAY that you should be paying that much.

Get those gloves out, girl, and let them have it! :tt1:

[msdv 5]

^^^ Even if they used a gold tube they didn't give it to her. They kept it .

This is outright greed.

I would definitely take this public and embarrass all of them royally and then sue them for distress or whatever I could.