Wellness

[Roni18]

@Laura14 I am not an insurance expert and realize that different companies may have different policies, but this sounds very strange to me.  I've had 3 serious surgeries and 1 less serious one since 2020.  For each of these, the doctor's office handled everything with the insurance company.  The only thing I paid in advance was my hospital copay which I paid when I registered at the hospital.  

[We rescue cats]

@Laura14 - you are getting good advice, and I am so sorry that you are going thru this now. It's the last thing you need when facing surgery, the added anxiety is not good right now. I hope you get answers...soon!

[Laura14]

@We rescue cats  Thank you!

@Roni18 Thank you for telling me. I am going to call the three numbers tomorrow and see what they all estimate their cost to be. I plan on asking each of them if a patient ever did their own cost planning before or if they usually deal with practice staff.

[JudyL]

@Laura14 - that's crazy!  I've never heard of such a thing.

[Laura14]

@moonandthestars I followed up tonight with my insurance and saw that she just submitted the pre-authorization request today for a three month period not the thirty days I was told she was limited to after I called her on not doing it.

Unless she expedited it, no way this approval comes through by next Tuesday which means everything gets pushed or cancelled now. This doesn't just affect me. I had family set to help me and an employer ready to give me leave on the specific scheduled dates. 

Thank you all for educating me on how this should have transpired. I'll know better for next time. I think the best healthcare I can receive at this point is to walk away as some of you and others in my life have said for a while now and start over at another practice later this year.

[simplyfriends]

@Laura14    I must of missed what surgery you need. The ONLY reason you would pay any money in advance is if it was an elective surgery (no medically necessary).  

[FancyPhillyshopper]

I would never pay anything in advance!

The practice is at fault here for lack of coordination.

A patient should not have to call various staff and get cost estimates.  

The most I ever had to do was once call an insurance company to discuss a pre-approval, but almost always doctors take care of the preapprovals on behalf of the patients.

Perhaps all of these issues may be caused by the type of insurance you have. 

I know there are a lot of stories about people with low-coverage or no insurance who have to pay out of their own pockets for some parts, and then they call and check out all the costs. Also, if you are out of network, there are additional horror stories.

It sounds like you need a patient advocate to help you work through the system. Maybe your state or county department of health has some information to assist. Does your employer have a benefits office that can review your coverage with you?

Best wishes!

[Laura14]

@FancyPhillyshopper I am the benefits person at my small employer. 😂 We actually have fairly decent insurance compared to what we use to have under a previous owner. We are in network. I'm not an expert but I paid attention at the benefits presentation.

Because I know what I know and I'm slightly dangerous, it's the reason I've been all over her because I know she's not doing what I think she should and what the practice told me she should. 

Thank you all for your experiences. It's very helpful. I'm looking forward to what these cost estimator people have to say today and if they ever talked directly to a patient before. 

[ScrapHappy]

Every year I have a breast MRI done att the same outpatient facility.  Every year I make the appointment way ahead of time because I know it takes at least 2 weeks for my insurance company for pre-authorization.  But, every year the facility waits until 2 days to start the process.  I've complained about this and I think this last time I got their attention.  But anyway, I was denied this go around so going forward I will probabaly for go pre-athorization and just pay out of pocket.  It is up to the hospital and your doctor to provide  your insurance company with the information required for pre-authorization.  

[IMW]

No, find another md.