Re: Would you pay towards a surgery before pre-aut... - Page 5

wagirl · ‎03-09-2010

no!! I would let insurance take care of that----I know you can ask the cost of some procedures before hand. See signs in all the offices I go to, about that.

chrystaltree · ‎05-10-2010

This is what I did professionally for 25 years. I obtained authorizations surgical procedures and appealed insurance denials. I'm really confused with the narrative but I think you are saying is that the scheduler failed to obtain authorization from your insurers and expects you to obtain it yourself with just the CPT codes. My guess is, she was overwhelmed with work and your case fell through the cracks. She never requested authorization and now it's too late. Many insurers require 30 days for elective surgeries. If I were you, I'd call the pre-authorization department at the your insurance company first and give them the CPT codes and ask if pre-authorization is required. There are some elective procedures that don't require pre-authorization. Ask if the scheduler has submitted the request for pre-authorization and the the clinical documents. Ask for the status. If nothing is pending with them, your only recourse is to reschedule your surgery and demand that the scheduler do her job! You need that pre-authorization to protect yourself. If you don't have it on the day of surgery, YOU are responsible for the charges. AAL the charges, including the hospital charges. Hence that waiver they want you to sign. Hence my the deposit you'll be asked for. The scheduler made a mess of this and like most of them, she hasn't told the surgeon that there's no authorization for something that was scheduled so long ago. You should let him know. Yes, it is common to ask for patient deposits under when pre-authorization is pending and the patient does not want to reschedule the surgery.

Laura14 · ‎06-09-2014

@chrystaltree Thank you.

Actually, the CPT codes were to estimate what the cost was for the hospital and anesthesia bills. She only ran the insurance for the doctor's fees.I did the calling around for everything else.

Had they let me know I would do that and asked me to on day one, I could have saved myself and them two months worth of grief, because the hospital bill alone, if I did it right and understand the estimate, is beyond my financial ability even with insurance.

I did try to submit the pre-authorization myself back in April because I saw the writing on the wall. They told me the provider had to do it.

I immediately emailed the scheduler and the practice because I didn't know who submitted and asked them to please submit and anything I could do to help them get it through, let me know. Crickets, but it did force her hand to get me a surgery date I had waited 3 weeks for her to call on.

She then told me she would do it on that day since she had to have the date to do it. And now the latest lie is she couldn't do it on that day because she couldn't submit until 30 days out from the surgical date.

She didn't submit 30 days out. She actually submitted this Tuesday when they wanted me to give them the doctor money and waiver and I said no way, jose. Either you put through the authorization paperwork or I stay home and you collect nothing.

At this point, it's moot because the other fees are beyond my budget, but I am waiting to cancel outright because #1 I want her to sit and suffer and #2 I want the free second opinion from insurance company doctors since this has been shady all the way around. It makes me wonder about everything now although I think the doctor was playing it straight with me.

This is all going to blow up in her face next week when I cancel the pre-op appointment and tell them why. I don't usually take pleasure in hot seats, but this girl more than earned it and I am all about consequences for bad behavior.

Hopefully, it saves the next me from her.

Lucky Charm · ‎03-09-2010

I had my colonoscopy a few months ago. They called me ahead of time and told me what I would owe after my insurance coverage is used. So I agreed to a 10 month payment plan as I never see the need to pay them all up front, since you don't have to.

I received a check back from them from my payment last month. Same exact amount they billed me (my agreed upon payment). My insurance did cover the colonoscopy 100%. I'll be getting a check from them for my payment from the beginning of this month.

I wish I'd thought to ask about the attending nurse and anesthesiologist! (A phone number for each) Because obviously mine weren't *in network* and I got stuck with a bill for them. (My insurance only paid 50% of their fees.) And they both charged the same exact amount $480/ea, which I think is a little ironic. So, I put them on a 4 month payment plan.

GoneButNotForgotten · ‎03-29-2020

@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.

And do take excrutiatingly detailed notes of every communication, no matter who it is.Get the name of who you're taliking to and what entity they're with, note the day and time, and an accurate description of your communication. Keep your written notes where you can get your hands on them quickly. Also, if I were you--and I have been--I'd also type up the handwritten notes on a Word file or some other electronic media, in case something gets lost.

I've been in your shoes and you're right to NOT give them a cent till you know that your insurance company has approved whatever it is that you're having done. I'm having a small ($20,000) procedure done soon and the hospital wouldn't hardly talk to me till they got the approval from Medicare.

Good luck to you and let us know what happens.

Laura14 · ‎06-09-2014

Thank you @GoneButNotForgotten . Everything is in emails so I can burn her to the ground at any time and she fully knows it. Probably happen on Tuesday when they remind me of the pre-op appointment I am not attending.

The hospital called me for preparation stuff and I had to tell them my surgery scheduler never processed my paperwork to get them paid and, until I know they will be compensated for their services, I'm on hold. So embarrassing to waste everyone's time and have me make an apology on her incompetence.

At least I am spreading her "good" name among the industry pros she has to work with.

CelticCrafter · ‎03-09-2010

@Laura14 , so what happened and what's the final result?

Laura14 · ‎06-09-2014

@CelticCrafter I am so sorry for not seeing this until now. I made the girl do the insurance pre-authorization and refused any pre op appointments until she had it in hand because, one, I wanted a free second opinion and two, I wanted to make her do her job.

The insurance company approved everything which is good info for me to know about myself. I then cancelled the whole thing with her and told her the reason was I was no longer comfortable with the practice after my experience with her and the surgery scheduling process.

I felt it was unnecessarily difficult and to ask a patient to be vulnerable and trust the practice for something as serious as an operation was something I could no longer find a comfort level with after the ongoing lack of communication and effort.

I'm still considering writing a Google review and warning others.