topic Re: Would you pay towards a surgery before pre-authorization approval? in Wellness

Would you pay towards a surgery before pre-authorization approval?

Laura14 — Tue, 09 May 2023 18:40:42 GMT

As a follow up to my last question in which you all told me I was okay, I have another.

The surgery scheduler shocked me by actually following up last night after a month, but not with the insurance information I was supposed to get and have been waiting two months for.

Instead, I got five CPT codes and three phone numbers for the hospital, anesthesiologists and nurses to call and figure it out myself.

The only thing she ran through the insurance was the doctor's fee of about $3000 and that I had to sign a personal guaranty in case the insurance declined. Bring the check next week to the pre-op appointment or no surgery for you.

Um, pre-authorization anyone?

When I emailed her back, I was told on 4/11 when I finally had a surgery date, she would submit the insurance paperwork. But she never did.

Today, I get the excuse that she couldn't put it in back in April because it was more than 30 days out. I'm calling BS on that one and told her I'm not showing up next week for a pre-op appointment with a check and personal guaranty and no pre-authorization.

And if she submitted it late, that was an issue I tried my best to avoid six weeks ago with a little thing called communication about the insurer's 2 week lead time four weeks ago.

If she submitted it at 30 days it should be no issue to get a two week authorization by 5/17. If she just did it today, which I know she did, guess who's not coming to pre-op and guess which practice is not collecting what's probably a $10,000 check after all is said and done?

Just so that I know, is it really normal to be asked to put down thousands of dollars without any insurance pre-approval? I can't imagine the person who would pay ahead and then take their chances that the insurance company doesn't decline at the last minute. But maybe it's just me.

And do you guys really call the hospital and anesthesiologists yourselves to get your cost estimates? I'm so amazed and not in a good way.

Re: Would you pay towards a surgery before pre-authorization approval?

lynnie61 — Tue, 09 May 2023 18:51:57 GMT

@Laura14 Good grief you've been through a lot. Take care. I hope it works out for you.

Re: Would you pay towards a surgery before pre-authorization approval?

Mz iMac — Tue, 09 May 2023 18:58:48 GMT

@Laura14 NOPE!

You need to call your insurance company to let them know what is going on exactly like you did in your post. They will either handle it directly w/your medical providers or instruct you what to do next.

Re: Would you pay towards a surgery before pre-authorization approval?

ruthbe — Tue, 09 May 2023 19:02:50 GMT

I am definitely not an expert....but I would not pay like that up front. remember I am not an expert. But if it was me....my next call would be to a supervisor and explain the situation. I would write down what I wanted to say...in a logical order. And when I talked to the supervisor/manager...just talk facts...don't get emotional.

All of the pre authorization and approvals from insurance should be taken care of before the surgery.

I work in medical records....but the coding of diagnoes and procedures. Not the insurance stuff.

But remember...I am not the expert. Good luck and I hope everything works out...especially the surgery

Re: Would you pay towards a surgery before pre-authorization approval?

Tinkrbl44 — Tue, 09 May 2023 19:03:57 GMT

@Mz iMac wrote:
@Laura14 NOPE!

You need to call your insurance company to let them know what is going on exactly like you did in your post. They will either handle it directly w/your medical providers or instruct you what to do next.

ITA ... your insurance needs to know what is going on here. You don't pay anything for something that hasn't even been approved yet.

Re: Would you pay towards a surgery before pre-authorization approval?

Laura14 — Tue, 09 May 2023 19:04:11 GMT

@Mz iMac Thanks!

I have contacted my insurance several times. I asked them back in April if I could do the pre-authorization myself because I saw the writing on the wall. They said no and to let the practice know they had a two week lead time on their end and to get it in.

I emailed two different people, asked what I could do to help, and got crickets until I refused payment without authorization last night.

Glad to know I'm still thinking right. I know the world has changed but giving a business thousands of dollars with no assurance that the surgery was even going to happen was a new one on me.

Re: Would you pay towards a surgery before pre-authorization approval?

SnowOwl79 — Tue, 09 May 2023 19:05:48 GMT

Holy moly. I didn't see your first question but I'd have serious concerns about this particular surgeon. I've never heard of a patient having to submit all of that paperwork, and think she's not doing her job.

Re: Would you pay towards a surgery before pre-authorization approval?

deepwaterdotter — Tue, 09 May 2023 19:08:48 GMT

@Mz iMac wrote:
@Laura14 NOPE!

You need to call your insurance company to let them know what is going on exactly like you did in your post. They will either handle it directly w/your medical providers or instruct you what to do next.

This sounds like good advice.

Re: Would you pay towards a surgery before pre-authorization approval?

CelticCrafter — Tue, 09 May 2023 19:18:37 GMT

I would not pay that amount of money upfront and wait to be reimbursed?

Reading what you have gone through with this office I wouldn't trust them to make sure the paper work was submitted to the insurance company for you to be reimbursed.

If the "surgery scheduler" gave you the information to set this surgery up yourself, what exactly does she do to have that title?

This sounds like some shady practice.

Re: Would you pay towards a surgery before pre-authorization approval?

Laura14 — Tue, 09 May 2023 19:22:59 GMT

My thoughts exactly @CelticCrafter . There is no way I'm getting into a refund situation with the practice or the insurance company. Either it's paid for or it's not.

Maybe other people have thousands of dollars lying around for sport and to take a gamble. I do not.

I appreciate everyone's input again. I'm glad I'm still thinking correctly and I'm not the problem child.

Re: Would you pay towards a surgery before pre-authorization approval?

AZfem — Tue, 09 May 2023 19:59:41 GMT

In my experience with surgeries, the insurance is filled first & then you are billed for the balance after insurance pays. Your insurance company should be able to give you an idea of your co pays to hospital, drs., etc. The scheduler should have everything set up before you go in. Can you talk to the dr. or office manager about this? Can you go to another dr.? Have you checked reviews on this office to see if others had these problems?

Re: Would you pay towards a surgery before pre-authorization approval?

Tinkrbl44 — Tue, 09 May 2023 20:15:13 GMT

@Laura14 wrote:
My thoughts exactly @CelticCrafter . There is no way I'm getting into a refund situation with the practice or the insurance company. Either it's paid for or it's not.

Maybe other people have thousands of dollars lying around for sport and to take a gamble. I do not.

I appreciate everyone's input again. I'm glad I'm still thinking correctly and I'm not the problem child.

@Laura14

You are not the problem child here.

And @AZfem made a good point ... call the Office Mgr of the practice and tell them what's going on.

I suppose it's entirely possible the Ofc Mgr doesn't realize that some people working there might need more training.

Re: Would you pay towards a surgery before pre-authorization approval?

Laura14 — Tue, 09 May 2023 20:20:01 GMT

That was what I thought happened @AZfem . I never thought I'd call around myself. Why not give us that information on day one if she won't make the calls like the info sheet said she would?

I am lucky to have a BIL who works for the hospital and I do have a referral for another practice from him for a doctor he's good friends with. At some point, once I recover, I might try it all again there.

And believe it or not, people rave about this practice. It's 4.9 stars out of 5 and the others in the area have these nightmare scenarios. I guess I'm special or just that out of touch with my expectations. I seem to be the lone horrific experience. .

If I thought I had ever met these people, I'd almost think it was personal. I know the scribe hates my employer, but what does that have to do with me and my healthcare needs? It's such nonsense.

Re: Would you pay towards a surgery before pre-authorization approval?

PinkyPetunia — Tue, 09 May 2023 20:29:27 GMT

A family member of mine had elective surgery recently. He was asked to pay the co-pay the day of surgery, knowing the procedure was approved by insurance and was told how much insurance would pay.

All requests for approval were handled by the doctor's office. It went smoothly, no delays or additional requests for payment.

I am sorry the OP is having so much trouble setting this surgery up. It doesn't sound kosher to me.

Re: Would you pay towards a surgery before pre-authorization approval?

Carmie — Tue, 09 May 2023 20:41:01 GMT

Is the provider participating with your insurance? Patients are not able to get pre-auth for surgery. The insurance company will probably request records and other info from the provider's office that you don't have.

The insurance co. will send notice of approval or denial to the provider and patient. DO NOT prepay and go ahead with surgery without pre-auth especially ifthe doctor does not participate. Somethimes there are penalities involved for not getting approval, if the provider is participating, they might have to eat the bill if it is not approved, but there are other providers involved...anesthesiologists, lab techs, etc who could bill you.

I would complain directly to the doctor. His/her employee is not doing their job.

Re: Would you pay towards a surgery before pre-authorization approval?

Laura14 — Tue, 09 May 2023 20:43:56 GMT

Thank you @Carmie 🙏🏻

Re: Would you pay towards a surgery before pre-authorization approval?

NicksmomESQ — Tue, 09 May 2023 21:38:44 GMT

@Laura14 I would not deal with that office at all. They have no right to tell you to get yourself pre authorized for surgery & ask you for 10K upfront. That's what they have staffs for.

My husband has had several procedures & treatments. The doctors office always got pre approval. We were never asked to lay out a dime.

My husband is having surgery the end of June. The day the surgeon advised us it was necessary, we were sent down the hall to the scheduling office. By the time we left we already had pre approval & an appointment for pre op testing.

Someone isn't doing their job & something sounds very fishy. I would call the insurance company & tell them what happened.You should also let the doctor know what his staff is up to.

With all your going through I'm sorry you're being put through this!!

Re: Would you pay towards a surgery before pre-authorization approval?

Laura14 — Tue, 09 May 2023 22:03:14 GMT

Thank you so much @NicksmomESQ . With no experience, it's easy to not know and get taken advantage of. Very grateful to you and everyone here. 🙏🏻

Re: Would you pay towards a surgery before pre-authorization approval?

hckynutjohn — Tue, 09 May 2023 23:06:27 GMT

(thread title question)

@Laura14

No.

hckynut 🇺🇸

Re: Would you pay towards a surgery before pre-authorization approval?

moonandthestars — Tue, 09 May 2023 23:22:23 GMT

@Laura14 I agree with those that advised to wait for the insurance pre-approval. My insurance, I believe, requires pre-approval in order to reimburse for some things. I wouldn't take the chance that moving forward without the pre-approval would hurt the chances of reimbursement. And also agree to up this to a higher level at the dr's office. Also keep following up with your insurance company to see if they've received anything from the dr's office.

I'm guessing there are good reviews for this practice because of the work that the dr. does as opposed to how the office is run.