Wellness

[AZfem]

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?

[Tinkrbl44]

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@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. 

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@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.  

[Laura14]

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. 

[PinkyPetunia]

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.  

[Carmie]

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.

[Laura14]

Thank you @Carmie 🙏🏻

[NicksmomESQ]

 @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!!

[Laura14]

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. 🙏🏻

[hckynutjohn]

(thread title question)

@Laura14 

No.

hckynut 🇺🇸

[moonandthestars]

@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.