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

Laura14 · ‎06-09-2014

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.

lynnie61 · ‎04-28-2010

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

Mz iMac · ‎07-26-2014

@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.

"Never argue with a fool. Onlookers may not be able to tell the difference."

ruthbe · ‎05-05-2016

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

Tinkrbl44 · ‎08-23-2010

@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.

Laura14 · ‎06-09-2014

@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.

SnowOwl79 · ‎01-09-2021

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.

deepwaterdotter · ‎03-09-2010

@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.

CelticCrafter · ‎03-09-2010

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.

Laura14 · ‎06-09-2014

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.